Kshivets Oleg LOCAL ADVANCED LUNG CANCER: PRECISE PREDICTION

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LOCAL ADVANCED LUNG CANCER: PRECISE PREDICTION OF 5-YEAR SURVIVAL AFTER COMBINED LOBECTOMIES/PNEUMONECTOMIES Oleg Kshivets Surgery Department, Kaluga Cancer Center, Kaluga, Russia OBJECTIVE: We examined factors in terms of precise prediction of 5-year survival (5YS) of local advanced non-small cell lung cancer (LC) patients (LCP) (T3-4N0-2M0) after complete (R0) combined lobectomies/pneumonectomies (LP). METHODS: We analyzed data of 167 consecutive LCP (age=58±8.1 years; tumor size=6.8±2.6 cm) radically operated and monitored in 1987-2014 (m=150, f=17; lobectomies=70, pneumonectomies=97, combined LP with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=167; only surgery-S=105, adjuvant chemoimmunoradiotherapy-AT=62: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T3=117, T4=50; N0=79, N1=38, N2=50, M0=167; G1=36, G2=44, G3=87; squamous=113, adenocarcinoma=41, large cell=13. Multivariate Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence. RESULTS: Overall life span (LS) was 1483.1±1412.6 days and cumulative 5YS reached 60.3%, 10 years – 45.9%, 20 years – 30.1%. 77 LCP lived more than 5 years without cancer (LS=2616.2±1341. days). 61 LCP died because of LC (LS=466.1±360.0 days). AT significantly improved 5YS (77.2% vs. 51.4%) (P=0.0004 by log-rank test). Cox modeling displayed (Chi2=68.5, df=10, P=0.000) that 5YS of LCP significantly depended on: T3-4, N0-2, tumor size, cell ratio factors (ratio between cancer cells and blood cells subpopulations), prothrombin index, heparin tolerance, fibrinogen B, AT (P=0.000-0.033). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and AT (rank=1), N0-2 (rank=2), T3-4 (3), prothrombin index (4), thrombocytes/cancer cells (5), lymphocytes/cancer cells (6), tumor size (7). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0). CONCLUSIONS: 5YS of local advanced non-small cell lung cancer patients after radical procedures significantly depended on: tumor characteristics, cell ratio factors, hemostasis system and adjuvant treatment.

Health & Medicine

Disclosure of Interest: None DeclaredPoster 1147
LOCAL ADVANCED
LUNG CANCER:
PRECISE PREDICTION
OF 5-YEAR SURVIVAL
AFTER COMBINED
LOBECTOMIES/
PNEUMONECTOMIES
Surgery Department
Kaluga Cancer Center,
Kaluga, Russia
Oleg Kshivets, MD, PhD
4.8 Scientific Studies - Treatment

METHODS: We analyzed data of 167 consecutive LCP (age=58±8.1
years; tumor size=6.8±2.6 cm) radically operated and monitored in
1987-2014 (m=150, f=17; lobectomies=70, pneumonectomies=97,
combined LP with resection of trachea, carina, atrium, aorta, VCS,
vena azygos, pericardium, liver, diaphragm, ribs, esophagus=167;
only surgery-S=105, adjuvant chemoimmunoradiotherapy-AT=62:
CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy;
T3=117, T4=50; N0=79, N1=38, N2=50, M0=167; G1=36, G2=44,
G3=87; squamous=113, adenocarcinoma=41, large cell=13.
Multivariate Cox modeling, clustering, SEPATH, Monte Carlo,
bootstrap and neural networks computing were used to determine
any significant dependence.
RESULTS: Overall life span (LS) was 1483.1±1412.6 days and
cumulative 5YS reached 60.3%, 10 years – 45.9%, 20 years –
30.1%. 77 LCP lived more than 5 years without cancer
(LS=2616.2±1341. days). 61 LCP died because of LC
(LS=466.1±360.0 days). AT significantly improved 5YS (77.2% vs.
51.4%) (P=0.00043 by log-rank test). Cox modeling displayed
(Chi2=68.5, df=10, P=0.000) that 5YS of LCP significantly depended
on: T3-4, N0-2, tumor size, cell ratio factors (ratio between cancer
cells and blood cells subpopulations), prothrombin index, heparin
tolerance, fibrinogen B, AT (P=0.000-0.033).
LOCAL ADVANCED LUNG CANCER:
PRECISE PREDICTION OF 5-YEAR
SURVIVAL AFTER COMBINED
LOBECTOMIES/PNEUMONECTOMIES
Oleg Kshivets
Poster 1147 Disclosure of Interest: None Declared
OBJECTIVE: We examined factors in terms of precise prediction of
5-year survival (5YS) of local advanced non-small cell lung cancer
(LC) patients (LCP) (T3-4N0-2M0) after complete (R0) combined
lobectomies/pneumonectomies (LP).
Variables in the Equation Cox
Chi2=68.5; df=10; P=0.000 B SE Wald df Sig. Exp(B)
T3--4 -,453 ,212 4,559 1 ,033 ,636
N12--N0 9,820 2 ,007
N12--N0(1) -,650 ,208 9,803 1 ,002 ,522
N12--N0(2) -,383 ,234 2,675 1 ,102 ,682
Tumor Size ,140 ,046 9,253 1 ,002 1,150
Prothrombin Index ,033 ,008 18,528 1 ,000 1,033
Fibrinogen-B ,442 ,152 8,441 1 ,004 1,556
Heparin Tolerance ,002 ,001 4,748 1 ,029 1,002
Adjuvant Chemoimmunoradiotherapy -,306 ,101 9,164 1 ,002 ,736
Thrombocytes/Cancer Cells ,004 ,001 9,835 1 ,002 1,004
Lymphocytes/Cancer Cells -,261 ,109 5,700 1 ,017 ,770

LOCAL ADVANCED LUNG CANCER:
PRECISE PREDICTION OF 5-YEAR
SURVIVAL AFTER COMBINED
LOBECTOMIES/PNEUMONECTOMIES
Oleg Kshivets
Bootstrap Simulation for 5-Year Survival
Significant Factors (Number of Samples=3333)
Rank Kendal Tau-A P <
Prothrombin Index 1 -0.211 0.00
1
Erythrocytes/Cancer Cells 2 0.155 0.01
Erythrocytes
Weight
3
4
0.152
0.151
0.01
0.01
Monocytes/Cancer Cells 5 0.145 0.05
Glucose 6 0.144 0.05
Healthy Cells/Cancer Cells 7 0.131 0.05
ESS 8 -0.127 0.05
N0---N12 9 -0.119 0.05
Eosinophils/Cancer Cells 10 0.115 0.05
Poster 1147 Disclosure of Interest: None Declared
CONCLUSIONS: 5YS of local advanced non-small cell lung cancer
patients after radical procedures significantly depended on: tumor
characteristics, cell ratio factors, hemostasis system and adjuvant
treatment.
Neural Networks Computing for 5-Year Survival
Factor
Rank Sensitivity
Adjuvant Chemoimmunoradiotherapy 1 2877
N0---N12 2 2525
T3-4 3 2246
Prothrombin Index 4 1640
Thrombocytes/Cancer Cells 5 1538
Lymphocytes/Cancer Cells 6 1325
Tumor Size 7 1264
Neural networks, genetic algorithm selection and bootstrap
simulation revealed relationships between 5YS and AT (rank=1),
N0-2 (rank=2), T3-4 (3), prothrombin index (4),
thrombocytes/cancer cells (5), lymphocytes/cancer cells (6),
tumor size (7). Correct prediction of 5YS was 100% by neural
networks computing (error=0.000; area under ROC curve=1.0).

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OBJECTIVE: 5-survival (5YS) and life span after radical surgery for esophageal cancer (EC) pa¬tients (ECP) (T1-4N0-2M0) was analyzed. METHODS: We analyzed data of 556 consecutive ECP (age=56.5±8.9 years; tumor size=6±3.5 cm) radically operated (R0) and monitored in 1975-2022 (m=415, f=141; esophagogastrectomies (EG) Garlock=287, EG Lewis=269, combined EG with resection of pancreas, liver, diaphragm, aorta, VCS, colon transversum, lung, trachea, pericardium, splenectomy=167; adenocarcinoma=318, squamous=228, mix=10; T1=129, T2=115, T3=184, T4=128; N0=281, N1=70, N2=205; G1=157, G2=141, G3=258; early EC=110, invasive=446; only surgery=424, adjuvant chemoimmunoradiotherapy-AT=132: 5-FU+thymalin/taktivin+radiotherapy 45-50Gy). Multivariate Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence. RESULTS: Overall life span (LS) was 1877±2221.6 days and cumulative 5-year survival (5YS) reached 52%, 10 years – 45%, 20 years – 33.4%, 30 years – 27%. 186 ECP lived more than 5 years (LS=4283.3±2412.6 days), 99 ECP – more than 10 years (LS=5883±2296.6 days). 227 ECP died because of EC (LS=631.8±323.4 days). AT significantly improved 5YS (60.3% vs. 42%) (P=0.0029 by log-rank test). Cox modeling displayed that 5YS of ECP significantly depended on: phase transition (PT) N0—N12 in terms of synergetics, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), T, G, histology, age, AT, localization, prothrombin index, hemorrhage time, residual nitrogen, protein (P=0.000-0.021). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and P PT early-invasive EC (rank=1); healthy cells/CC (2), erythrocytes/CC (3), PT N0—N12 (4) thrombocytes/CC (5); segmented neutrophils/CC (6), stick neutrophils/CC (7), lymphocytes/CC (8), monocytes/CC (9); leucocytes/CC (10); eosinophils/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0). CONCLUSIONS: 5-year survival of ECP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) tumor localization; 10) anthropometric data; 11) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.

Esophageal Cancer: Precise Prediction

Oleg Kshivets

OBJECTIVE: This study aimed to determine surgery type influence for 5-year survival (5YS) of non-small cell lung cancer (LC) patients (LCP) after complete en block (R0) lobectomies and pneumonectomies. METHODS: We analyzed data of 765 consecutive patients (age=57.6±8.3 years; tumor size=4.1±2.4 cm) radically operated (R0) and monitored in 1985-2022 (m=659, f=106; bi/lobectomies=512, pneumonectomies=253, mediastinal lymph node dissection=765; combined procedures with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=192; only surgery-S=616, adjuvant chemoimmunoradiotherapy-AT=149: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T1=318, T2=255, T3=133, T4=59; N0=514, N1=131, N2=120, M0=765; G1=194, G2=241, G3=330; squamous=417, adenocarcinoma=298, large cell=50; early LC=212, invasive LC=553. Multivariate Cox modeling, discriminant analysis, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence. RESULTS: Overall life span (LS) was 2240.1±1751.6 days and cumulative 5-year survival (5YS) reached 72.8%, 10 years – 64.2%, 20 years – 42.9%. 499 LCP lived more than 5 years (LS=3126.8±1540 days), 143 LCP – more than 10 years (LS=5083.3±1518.6 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (77.6% vs.63.1%, P=0.00001 by log-rank test). AT significantly improved 5YS (64.4% vs. 34.8%) (P=0.00003 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). 5YS of LCP after Lobectomies (77.6%) was significantly superior in comparison with LCP after pneumonectomies (63%) (P=0.00001 by log-rank test). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12(rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), segmented neutrophils/CC (7), lymphocytes/CC (8), monocytes/CC (9); stick neutrophils/CC (10), leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0). CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) surgery type: lobectomy/pneumonectomy; 10) anthropometric data.

Survival of Lung Cancer Patients after Lobectomies was Significantly Superior...

Oleg Kshivets

OBJECTIVE: We examined cell ratio factors (CRF) significantly affecting gastric cancer (EC) patients GCP) survival. CRF - ratio between cancer cells (CC) and blood cells subpopulations. METHODS: We analyzed data of 799 consecutive GCP (T1-4N0-2M0) (age=57.1±9.4 years; tumor size=5.4±3.1 cm) radically operated (R0) and monitored in 1975-2022 (m=558, f=241; total gastrectomies=173, distal gastrectomies=461; proximal gastrectomies=165; combined gastrectomies=247 with resection of esophagus, pancreas, liver, duodenum, diaphragm, colon transversum, splenectomy, etc; only surgery-S=624, adjuvant chemoimmunotherapy-AT=175 (5-FU + thymalin/taktivin); T1=238, T2=220, T3=184, T4=157; N0=437, N1=109, N2=253, M0=799; G1=222, G2=164, G3=413. Variables selected for prognosis study were input levels of 45 blood parameters, sex, age, TNMG, cell type, tumor size. Survival curves were estimated by the Kaplan-Meier method. Differences in curves between groups of GCP were evaluated using a log-rank test. Multivariate Cox modeling, discriminant analysis, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence. RESULTS: Overall life span (LS) was 2128.9±2300.3 days and cumulative 5-year survival (5YS) reached 58.4%, 10 years – 51.9%, 20 years – 39%, 30 years – 27.2%. 318 GCP lived more than 5 years (LS=4304.5±2290.6 days), 169 GCP – more than 10 years (LS=5919.5±2020 days). 290 GCP died because of GC (LS=651±347.2 days). Cox modeling displayed that G CP survival significantly depended on CRF: healthy cells/CC, erythrocytes/CC, monocytes/CC, phase transition (PT) in terms of synergetics early—invasive cancer; PT N0--N12, age, G1-3, hemorrhage time, ESS, sex, AT, prothrombin index, residual nitrogen. Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early—invasive cancer (rank=1); PT N0--N12 (2); healthy cells/CC (3), erythrocytes/CC (4), thrombocytes/CC (5), monocytes/CC (6), segmented neutrophils/CC (7), leucocytes/CC (8), lymphocytes/CC (9), stick neutrophils/CC (10), eosinophils/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0). CONCLUSIONS: GCP survival after radical procedures significantly depended on CRF.

• Gastric cancer prognosis and cell ratio factors

Oleg Kshivets

It was revealed that separation of LCP with early LC (n=215) from invasive LCP (n=555) significantly depended on: Hb, leucocytes (abs, total), thrombocytes (abs, tot), erythrocytes (abs, tot), segmented neutrophils (%, abs, total), stick neutrophils (%, abs, total), lymphocytes (%), monocytes (abs, tot), ESS, coagulation time, fibrinogen, cell ratio factors (CRF) (ratio between cancer cells- CC and blood cells subpopulations), tumor size, age, tumor growth, T1-4, G1-3, PT N0---N12 (P=0.046-0.000). Neural networks computing, genetic algorithm selection and bootstrap simulation revealed relationships of PT early—invasive cancer and CRF: healthy cells/CC (rank=1), erythrocytes/CC (2), stick neutrophils/CC (3), thrombocytes/CC (4), eosinophils/CC (5), segmented neutrophils/CC (6), lymphocytes/CC (7), monocytes/CC (8), leucocytes/CC (9). Correct classification PT early—invasive cancer was 100% by neural networks computing (area under ROC curve=1.0; error=0.0). CONCLUSION: Blood cell circuit significantly influenced the phase transition early—invasive lung cancer.

Kshivets elcc2022

Oleg Kshivets

10-Year survival of GCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) GC characteristics; 9) anthropometric data; 10) surgery type. Optimal diagnosis and treatment strategies for GC are: 1) screening and early detection of GC; 2) availability of experienced abdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunotherapy for GCP with unfavorable prognosis.

Kshivets gc 10_ys_wjarr-2021-0659

Oleg Kshivets

Conclusions: 10-Year survival of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) anthropometric data; 10) surgery type. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.

Kshivets lc10 ys_wjarr

Oleg Kshivets

10-Year survival after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) tumor localization; 10) anthropometric data; 11) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.

Kshivets eso10 y2021

Oleg Kshivets

CONCLUSIONS: 10-Year survival after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) tumor localization; 10) anthropometric data; 11) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.

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Oleg Kshivets

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Lung cancer cell dynamics significantly depended on blood cell circuit, bioch...

Esophageal Cancer: Precise Prediction

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• Gastric cancer prognosis and cell ratio factors

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