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elcc-congress.org
LUNG CANCER: 10-YEAR SURVIVAL
#358
Kshivets Oleg
Surgery Department, Roshal Hospital, Moscow, Russia
No disclosures
e-mail: okshivets@yahoo.com

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EUROPEAN LUNG CANCER VIRTUAL CONGRESS 2021
DECLARATION OF INTERESTS
Oleg Kshivets
No disclosures

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EUROPEAN LUNG CANCER VIRTUAL CONGRESS 2021
LUNG CANCER: 10-YEAR SURVIVAL #358
Oleg Kshivets, MD, PhD
Surgery Department, Roshal Hospital, Roshal, Moscow, Russia
OBJECTIVE: 10-Year survial (10YS) after radical surgery for non-small cell lung cancer (LC) patients (LCP) (T1-4N0-2M0) was analyzed.
METHODS: We analyzed data of 768 consecutive LCP (age=57.6±8.3 years; tumor size=4.1±2.4 cm) radically operated (R0) and monitored in 1985-2021
(m=660, f=108; upper lobectomies=277, lower lobectomies=177, middle lobectomies=18, bilobectomies=42, pneumonectomies=254, mediastinal lymph node
dissection=768; combined procedures with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=193;
only surgery-S=618, adjuvant chemoimmunoradiotherapy-AT=150: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T1=320, T2=255, T3=133,
T4=60; N0=516, N1=131, N2=121, M0=768; G1=194, G2=243, G3=331; squamous=417, adenocarcinoma=301, large cell=50; early LC=214, invasive LC=554; right
LC=412, left LC=356; central=290; peripheral=478. Variables selected for 10YS 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 LCP 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 2244.9±1750.3 days and cumulative 5-year survival (5YS) reached 72.9%, 10 years – 64.3%, 20 yers – 43.1%. 502 LCP
lived more than 5 years (LS=3128.7±1536.8 days), 145 LCP – more than 10 years (LS=5068.5±1513.2 days).199 LCP died because of LC (LS=562.7±374.5 days).
AT significantly improved 10YS (52.4% vs. 27.7%) (P=0.00002 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 10YS 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, weight, color index (P=0.000-0.039).
Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 10YS and PT early-invasive LC (rank=1),
thrombocytes/CC (rank=2), PT N0—N12(rank=3), segmented neutrophils/CC (4), healthy cells/CC (5), lymphocytes/CC (6), erythrocytes/CC (7), stick
neutrophils/CC (8), eosinophils/CC (9), leucocytes/CC (10), monocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under
ROC curve=1.0; error=0.0).
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; 11) tumor localization.
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.

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EUROPEAN LUNG CANCER VIRTUAL CONGRESS 2021
DATA:
Males…………………………………….…………………………..…….660
Females…….......................................................................................108
Age=57.6±8.3 years Tumor Size=4.1±2.4 cm
Only Surgery.…..................................................................................618
Adjuvant Chemoimmunoradiotherapy (CAV/gemzar + cisplatin +
thymalin/taktivin, 5-6 cycles+ Radiotherapy 45-50Gy)...................150

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EUROPEAN LUNG CANCER VIRTUAL CONGRESS 2021
RADICAL PROCEDURES (R0):
Upper Lobectomies …………………….………………………………...277
Lower Lobectomies ……………..........................................................177
Middle Lobectomies………………….…..………………………………..18
Bilobectomies……………………………………..…………………….…..42
Pneumonectomies…………………………………………………..…....254
Combined Procedures with Resection of Carina, Trachea, Atrium,
Aorta, Liver, Vena Cava Superior, Vena Azygos, Diaphragm,
Pericardium, Ribs, Esophagus (R0)…………………………………...193
Mediastinal Lymph Node Dissection.……………………………….…768

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EUROPEAN LUNG CANCER VIRTUAL CONGRESS 2021
SURVIVAL RATE:
5-Year Survivors…………......................................................502 (65.4%)
10-Year Survivors……………………………………................145 (18.9%)
Losses……………………………………………………………..199 (25.9%)
General Life Span=2244.9±1750.3 days
For 5-Year Survivors=3128.7±1536.8 days
For 10-Year Survivors=5068.5±1513.2 days
For Losses=562.7±374.5 days
Cumulative 5-Year Survival……..……….........................................72.9%
Cumulative 10-Year Survival……..…...……………………………...64.3%
Cumulative 20-Year Survival………………………………………....43.1%

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EUROPEAN LUNG CANCER VIRTUAL CONGRESS 2021
GENERAL LUNG CANCER PATIENTS SURVIVAL AFTER COMPLETE
LOBECTOMIES/PNEUMONECTOMIES (KAPLAN-MEIER) (N=768):
Survival Function
5-Year Survival=72.9%; 10-Year survival=64.3%; 20-Year Survival=43.1%;
n=768; T1-4N0-2M0
Complete Censored
-5 0 5 10 15 20 25 30
Years after Lobectomies/Pneumonectomies
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Cumulative
Proportion
Surviving

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EUROPEAN LUNG CANCER VIRTUAL CONGRESS 2021
RESULTS OF UNIVARIATE ANALYSIS OF PHASE TRANSITION EARLY—INVASIVE
CANCER IN PREDICTION OF LUNG CANCER PATIENTS SURVIVAL (N=768):
Cumulative Proportion Surviving (Kaplan-Meier)
10-Year Survival of Early Lung Cancer Patients=93.9%;
10-Year Surival of Invasive Lung Cancer Patients=51.8%;
P=0.0000 by Log Rank Test
Complete Censored
0 5 10 15 20 25 30 35
Years after Lobectomies/Pneumonectomies
-0.2
0.0
0.2
0.4
0.6
0.8
1.0
Cumulative
Proportion
Surviving
Invasive Lung Cancer, n=554
Early Lung Cancer, n=214

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EUROPEAN LUNG CANCER VIRTUAL CONGRESS 2021
RESULTS OF UNIVARIATE ANALYSIS OF PHASE TRANSITION N0—N1-2 IN
PREDICTION OF LUNG CANCER PATIENTS SURVIVAL (N=768):
Cumulative Proportion Surviving (Kaplan-Meier)
10-Year Survival of Lung Cancer Patients with N0=78.3%;
10-Year Survival of Lung Cancer Patients with N1-2=35.2%;
P=0.0000 by Log Rank Test
Complete Censored
0 5 10 15 20 25 30 35
Years After Lobectomies/Pneumonectomies
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Cumulative
Proportion
Surviving
Lung Cancer with N1-2, n=252
Lung Cancer with N0=516

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EUROPEAN LUNG CANCER VIRTUAL CONGRESS 2021
RESULTS OF UNIVARIATE ANALYSIS OF ADJUVANT CHEMOIMMUNORADIOTHERAPY IN
PREDICTION OF LUNG CANCER PATIENTS SURVIVAL WITH N1-2 (N=252):
Cumulative Proportion Surviving (Kaplan-Meier)
10-Year Survival of LCP after AT=52.4%;
10-Year Survival of LCP after Surgery=27.7%;
P=0.00002 by Log Rank Test
Complete Censored
0 5 10 15 20 25 30
Years after Lobectomies/Pneumonectomies
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Cumulative
Proportion
Surviving
Only Surgery, n=164
Adjuvant Chemoimmunoradiotherapy, n=88

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EUROPEAN LUNG CANCER VIRTUAL CONGRESS 2021
Cumulative Proportion Surviving (Kaplan-Meier)
10-Year Survival after Lobectomies=72%;
10-Year Survival after Pneumonectomies=46.9%;
P=0.00002 by Log Rank Test
Complete Censored
0 5 10 15 20 25 30 35
Years after Lobectomies/Pneumonectomies
-0.1
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Cumulative
Proportion
Surviving
Pneumonectomies, n=254
Lobectomies, n=514
RESULTS OF UNIVARIATE ANALYSIS OF TYPE OF PROCEDURES IN
PREDICTION OF LUNG CANCER PATIENTS SURVIVAL (N=768):

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EUROPEAN LUNG CANCER VIRTUAL CONGRESS 2021
RESULTS OF UNIVARIATE ANALYSIS OF GENDER IN PREDICTION
OF LUNG CANCER PATIENTS SURVIVAL (N=768):
Cumulative Proportion Surviving (Kaplan-Meier)
10-Year Survival of Female LCP=73.4%;
10-Year Survival of Male LCP=63.4%;
P=0.0289 by Log Rank Test
Complete Censored
0 5 10 15 20 25 30 35
Years after Lobectomies/Pneumonectomies
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Cumulative
Proportion
Surviving
male, n=660
female, n=108

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EUROPEAN LUNG CANCER VIRTUAL CONGRESS 2021
RESULTS OF COX REGRESSION MODELING IN PREDICTION OF LUNG CANCER
PATIENTS SURVIVAL AFTER COMPLETE LOBECTOMIES/PNEUMONECTOMIES (N=768):
Cox Proportional Hazards Results,
LCP T1-4N0-2M0, n=768
Parameter
Estimate
Standard
Error
Chi-square P value
Thrombocytes/Cancer Cells -0.00550 0.001579 12.14276 0.000493
Healthy Cells/Cancer Cells 0.07391 0.024958 8.77037 0.003062
Adjuvant Chemoimmunoradiotherapy -1.13036 0.201727 31.39806 0.000000
Phase Transition N0---N12 1.12121 0.144416 60.27584 0.000000
Phase Transition Early-Invasive Cancer -1.47130 0.341717 18.53830 0.000017
Histology 0.35066 0.084684 17.14621 0.000035
G1-3 0.36443 0.087580 17.31503 0.000032
Color Index -2.18363 0.917025 5.67018 0.017256
Glucose -0.32526 0.078234 17.28559 0.000032
Prothrombin Index 0.03372 0.006854 24.20847 0.000001
Bilirubin 0.05124 0.018274 7.86319 0.005045
Recalcification Time -0.00444 0.001711 6.73236 0.009468
Heparin Tolerance 0.00392 0.000662 35.06287 0.000000
Thrombocytes (tot) 0.00172 0.000341 25.43339 0.000000
Monocytes -0.05039 0.024421 4.25828 0.039059
Weight -0.03451 0.008725 15.64460 0.000076

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EUROPEAN LUNG CANCER VIRTUAL CONGRESS 2021
RESULTS OF NEURAL NETWORKS COMPUTING IN PREDICTION OF LUNG CANCER
PATIENTS SURVIVAL AFTER COMPLETE LOBECTOMIES/PNEUMONECTOMIES (N=701):
Neural Networks: n=701;
Baseline Error=0.000;
Area under ROC Curve=1.000;
Correct Classification Rate=100%
Rank Sensitivity
Phase Transition Early--Invasive Cancer 1 11646
Thrombocytes/Cancer Cells 2 7184
Phase Transition N0--N12
Segmented Neutrophils/Cancer Cells
Healthy Cells/Cancer Cells
Lymphocytes/Cancer Cells
Erythrocytes/Cancer Cells
Stick Neutrophils/Cancer Cells
Eosinophils/Cancer Cells
Leucocytes/Cancer Cells
Monocytes/Cancer Cells
3
4
5
6
7
8
9
10
11
6656
4154
4407
3993
3370
2963
2224
1566
1206

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EUROPEAN LUNG CANCER VIRTUAL CONGRESS 2021
RESULTS OF BOOTSTRAP SIMULATION IN PREDICTION OF LUNG CANCER PATIENTS
SURVIVAL AFTER LOBECTOMIES/PNEUMONECTOMIES (N=701):
Bootstrap Simulation n=701
Significant Factors
(Number of Samples=3333)
Rank Kendall’Tau-A P<
Lymphocytes/Cancer Cells 1 0.269 0.000
Leucocytes/Cancer Cells 2 0.223 0.000
Healthy Cells/Cancer Cells 3 0.211 0.000
Erythrocytes/Cancer Cells 4 0.193 0.000
Thrombocytes/Cancer Cells 5 0.192 0.000
Lymphocytes (tot) 6 0.183 0.000
Segmented Neutrophils/Cancer Cells 7 0.173 0.000
Tumor Size 8 -0.118 0.000
Monocytes/Cancer Cells 9 0.111 0.000
PT Early---Invasive Cancer 10 0.107 0.000
Lymphocytes (%) 11 0.105 0.000
Segmented Neutrophils (%) 12 -0.102 0.000
Lymphocytes (abs) 13 0.096 0.000
Prothrombin Index 14 -0.094 0.001
T1-4 15 -0.094 0.001
PT N0---N12 16 -0.092 0.001
Procedures Type 17 0.087 0.01
Histology 18 0.076 0.01
Stick Neutrophils/Cancer Cells 19 0.073 0.01
Eosinophils/Cancer Cells 20 0.067 0.05
Age 21 -0.067 0.05
Fibrinogen 22 -0.052 0.05

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EUROPEAN LUNG CANCER VIRTUAL CONGRESS 2021
RESULTS OF KOHONEN SELF-ORGANIZING NEURAL NETWORKS COMPUTING IN PREDICTION OF
LUNG CANCER PATIENTS SURVIVAL AFTER LOBECTOMIES/PNEUMONECTOMIES (N=701):

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EUROPEAN LUNG CANCER VIRTUAL CONGRESS 2021
LUNG CANCER DYNAMICS:

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EUROPEAN LUNG CANCER VIRTUAL CONGRESS 2021
PROGNOSTIC EQUATION MODELS OF LUNG CANCER PATIENTS SURVIVAL
AFTER LOBECTOMIES/PNEUMONECTOMIES (N=701):

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EUROPEAN LUNG CANCER VIRTUAL CONGRESS 2021
PROGNOSTIC EQUATION MODELS OF LUNG CANCER PATIENTS SURVIVAL
AFTER LOBECTOMIES/PNEUMONECTOMIES (N=701):

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EUROPEAN LUNG CANCER VIRTUAL CONGRESS 2021
PROGNOSTIC SEPATH-MODEL OF LUNG CANCER PATIENTS SURVIVAL
AFTER LOBECTOMIES/PNEUMONECTOMIES (N=701):

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EUROPEAN LUNG CANCER VIRTUAL CONGRESS 2021
Conclusion:
10-Year survival of LCP after radical procedures significantly depended on:
1) phase transition early-invasive cancer;
2) phase transition N0--N12;
3) cell ratio factors;
4) blood cell circuit;
5) biochemical factors;
6) hemostasis system;
7) adjuvant chemoimmunoradiotherapy;
8) lung cancer characteristics;
9) anthropometric data;
10) surgery type;
11) tumor localization.

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EUROPEAN LUNG CANCER VIRTUAL CONGRESS 2021
Conclusion:
Optimal diagnosis and treatment strategies for lung cancer are:
1) screening and early detection;
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 lung cancer patients with
unfavorable prognosis.

23.
elcc-congress.org
Address: Oleg Kshivets, M.D., Ph.D.
Consultant Thoracic, Abdominal, General Surgeon
& Surgical Oncologist
e-mail: okshivets@yahoo.com
skype: okshivets
http: //www.ctsnet.org/home/okshivets