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01-12-2020 | NSCLC | LUNG CANCER SURGERY

Postoperative Adverse Events are Associated with Oncologic Recurrence Following Curative-intent Resection for Lung Cancer

Authors: Stephen Gowing, Laura Baker, Alexandre Tran, Zach Zhang, Hilalion Ahn, Jelena Ivanovic, Caitlin Anstee, Emma Grigor, Sebastien Gilbert, Donna E. Maziak, Farid Shamji, Sudhir Sundaresan, Patrick James Villeneuve, Andrew J. E. Seely

Published in: Lung | Issue 6/2020

Abstract

Background

Up to 50% of patients suffer short-term postoperative adverse events (AEs) and metastatic recurrence in the long-term following curative-intent lung cancer resection. The association between AEs, particularly infectious in nature, and disease recurrence is controversial. We sought to evaluate the association of postoperative AEs on risk of developing recurrence and recurrence-free survival (RFS) following curative-intent lung resection surgery.

Methods

All lung cancer resections at a single institution (January 2008–July 2015) were included, with prospective collection of AEs using the Thoracic Morbidity & Mortality System. Cox proportional hazards models were used to estimate the effect of AEs on recurrence, with results presented as hazard ratio (HR) with 95% confidence interval (CI). An a priori, clinically driven approach to predictor variable selection was used. Kaplan–Meier curves were used examine the relationship between AE and RFS. p < 0.05 was considered statistically significant.

Results

892 patients underwent curative-intent resection. 342 (38.3%) patients experienced an AE; 69 (7.7%) patients developed infectious AEs. 17.6% (n = 157) of patients had disease recurrence after mean follow-up of 26.5 months. Severe (Grade IV) AEs were associated with increased risk of recurrence (3.40; 95% CI 1.56–7.41) and a trend to decreased RFS. Major infectious AEs were associated with increased risk of recurrence (HR 1.71; CI 1.05–2.8) and earlier time to recurrence (no infectious AE 66 months, minor infectious 41 months, major infectious 54 months; p = 0.02).

Conclusion

For patients undergoing curative-intent lung cancer resection, postoperative AEs associated with critical illness or major infection were associated with increased risk of oncologic recurrence.

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Mitsudomi T, Suda K, Yatabe Y (2013) Surgery for NSCLC in the era of personalized medicine. Nat Rev Clin Oncol 10(4):235–244. https://doi.org/10.1038/nrclinonc.2013.22CrossRefPubMed

Hoffman PC, Mauer AM, Vokes EE (2000) Lung cancer. Lancet 355(9202):479–485. https://doi.org/10.1016/S0140-6736(00)82038-3CrossRefPubMed

Fedor D, Johnson WR, Singhal S (2013) Local recurrence following lung cancer surgery: incidence, risk factors, and outcomes. Surg Oncol 22(3):156–161. https://doi.org/10.1016/j.suronc.2013.04.002CrossRefPubMedPubMedCentral

Rueth NM, Parsons HM, Habermann EB, Groth SS, Virnig BA, Tuttle TM, Andrade RS, Maddaus MA, D'Cunha J (2011) The long-term impact of surgical complications after resection of stage I nonsmall cell lung cancer: a population-based survival analysis. Ann Surg 254(2):368–374. https://doi.org/10.1097/SLA.0b013e31822150feCrossRefPubMed

Andalib A, Ramana-Kumar AV, Bartlett G, Franco EL, Ferri LE (2013) Influence of postoperative infectious complications on long-term survival of lung cancer patients: a population-based cohort study. J Thoracic Oncol. https://doi.org/10.1097/JTO.0b013e3182862e7eCrossRef

Fernandez FG, Kosinski AS, Burfeind W, Park B, DeCamp MM, Seder C, Marshall B, Magee MJ, Wright CD, Kozower BD (2016) The society of thoracic surgeons lung cancer resection risk model: higher quality data and superior outcomes. Ann Thorac Surg 102(2):370–377. https://doi.org/10.1016/j.athoracsur.2016.02.098CrossRefPubMedPubMedCentral

Allen MS, Darling GE, Pechet TT, Mitchell JD, Herndon JE, 2nd, Landreneau RJ, Inculet RI, Jones DR, Meyers BF, Harpole DH, Putnam JB, Jr., Rusch VW, Group AZS (2006) Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg 81(3):1013–1019. https://doi.org/10.1016/j.athoracsur.2005.06.066CrossRef

Pucher PH, Aggarwal R, Qurashi M, Darzi A (2014) Meta-analysis of the effect of postoperative in-hospital morbidity on long-term patient survival. Br J Surg 101(12):1499–1508. https://doi.org/10.1002/bjs.9615CrossRefPubMed

Cools-Lartigue J, Spicer J, McDonald B, Gowing S, Chow S, Giannias B, Bourdeau F, Kubes P, Ferri L (2013) Neutrophil extracellular traps sequester circulating tumor cells and promote metastasis. J Clin Investig. https://doi.org/10.1172/jci67484CrossRefPubMed

10.

Gowing SD, Cool-Lartigue JJ, Spicer JD, Seely AJE, Ferri LE (2020) Toll-like receptors: exploring their potential connection with post-operative infectious complications and cancer recurrence. Clin Exp Metas. https://doi.org/10.1007/s10585-020-10018-2CrossRef

11.

Yin Y, Wang J, Wang X, Gu L, Pei H, Kuai S, Zhang Y, Shang Z (2015) Prognostic value of the neutrophil to lymphocyte ratio in lung cancer: a meta-analysis. Clinics (Sao Paulo, Brazil) 70(7):524–530. https://doi.org/10.6061/clinics/2015(07)10CrossRef

12.

Hong T, Shen D, Chen X, Cai D, Wu X, Hua D (2017) A novel systematic inflammation related index is prognostic in curatively resected non-metastatic colorectal cancer. Am J Surg. https://doi.org/10.1016/j.amjsurg.2017.07.021CrossRefPubMed

13.

Lieto E, Galizia G, Auricchio A, Cardella F, Mabilia A, Basile N, Del Sorbo G, Castellano P, Romano C, Orditura M, Napolitano V (2017) Preoperative neutrophil to lymphocyte ratio and lymphocyte to monocyte ratio are prognostic factors in gastric cancers undergoing surgery. J Gastrointest Surg. https://doi.org/10.1007/s11605-017-3515-xCrossRefPubMed

14.

Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, Postmus PE, Rusch V, Sobin L, International Association for the Study of Lung Cancer International Staging C, Participating I (2007) The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thoracic Oncology 2(8):706–714. https://doi.org/10.1097/JTO.0b013e31812f3c1aCrossRef

15.

Seely AJ, Ivanovic J, Threader J, Al-Hussaini A, Al-Shehab D, Ramsay T, Gilbert S, Maziak DE, Shamji FM, Sundaresan RS (2010) Systematic classification of morbidity and mortality after thoracic surgery. Ann Thorac Surg. https://doi.org/10.1016/j.athoracsur.2010.05.014CrossRefPubMed

16.

Andalib A, Ramana-Kumar AV, Bartlett G, Franco EL, Ferri LE (2013) Influence of postoperative infectious complications on long-term survival of lung cancer patients: a population-based cohort study. J Thorac Oncol 8(5):554–561. https://doi.org/10.1097/JTO.0b013e3182862e7eCrossRefPubMed

17.

Sawada S, Yamashita N, Suehisa H, Yamashita M (2013) Risk factors for recurrence after lung cancer resection as estimated using the survival tree method. Chest 144(4):1238–1244. https://doi.org/10.1378/chest.12-3034CrossRefPubMed

18.

Cruz C, Afonso M, Oliveiros B, Pego A (2017) Recurrence and risk factors for relapse in patients with non-small cell lung cancer treated by surgery with curative intent. Oncology 92(6):347–352. https://doi.org/10.1159/000458533CrossRefPubMed

19.

Luo H, Qiao L, Liang N, Zhang J (2015) Risk factors for recurrence in patients with resected N1 non-small cell lung cancer—a systematic review and meta-analysis. J BUON 20(3):791–799PubMed

20.

Choi PJ, Jeong SS, Yoon SS (2013) Prognosis of recurrence after complete resection in early-stage non-small cell lung cancer. Korean J Thorac Cardiovasc Surg 46(6):449–456. https://doi.org/10.5090/kjtcs.2013.46.6.449CrossRefPubMedPubMedCentral

21.

Ivanovic J, Mostofian F, Gilbert S, Maziak D, Shamji F, Sundaresan R, Villeneuve P, Seely A (2016) Evaluating impact of surgeon self-evaluation and positive deviance on post-operative adverse events following major thoracic surgery. Can J Surg 59(4):S110

22.

Farid SG, Aldouri A, Morris-Stiff G, Khan AZ, Toogood GJ, Lodge JP, Prasad KR (2010) Correlation between postoperative infective complications and long-term outcomes after hepatic resection for colorectal liver metastasis. Ann Surg 251(1):91–100. https://doi.org/10.1097/SLA.0b013e3181bfda3cCrossRefPubMed

23.

Fujita S, Teramoto T, Watanabe M, Kodaira S, Kitajima M (1993) Anastomotic leakage after colorectal cancer surgery: a risk factor for recurrence and poor prognosis. Jpn J Clin Oncol 23(5):299–302PubMed

24.

Ohtsuka T, Kitajima Y, Takahashi T, Sato S, Miyoshi A, Kohya N, Kitahara K, Nakafusa Y, Miyazaki K (2009) Infectious complications after gastric cancer surgery accelerate a rapid hepatic recurrence. Hepatogastroenterology 56(94–95):1277–1280PubMed

25.

Lin JK, Yueh TC, Chang SC, Lin CC, Lan YT, Wang HS, Yang SH, Jiang JK, Chen WS, Lin TC (2011) The influence of fecal diversion and anastomotic leakage on survival after resection of rectal cancer. J Gastrointest Surg 15(12):2251–2261. https://doi.org/10.1007/s11605-011-1721-5CrossRefPubMed

26.

Lerut T, Moons J, Coosemans W, Van Raemdonck D, De Leyn P, Decaluwe H, Decker G, Nafteux P (2009) Postoperative complications after transthoracic esophagectomy for cancer of the esophagus and gastroesophageal junction are correlated with early cancer recurrence: role of systematic grading of complications using the modified Clavien classification. Ann Surg 250(5):798–807. https://doi.org/10.1097/SLA.0b013e3181bdd5a8CrossRefPubMed

27.

Søgaard M, Thomsen RW, Bossen KS, Sørensen HT, Nørgaard M (2013) The impact of comorbidity on cancer survival: a review. Clin Epidemiol 5(Suppl 1):3–29. https://doi.org/10.2147/clep.S47150CrossRefPubMedPubMedCentral

28.

Nechuta S, Lu W, Zheng Y, Cai H, Bao PP, Gu K, Zheng W, Shu XO (2013) Comorbidities and breast cancer survival: a report from the Shanghai Breast Cancer Survival Study. Breast Cancer Res Treat 139(1):227–235. https://doi.org/10.1007/s10549-013-2521-2CrossRefPubMedPubMedCentral

29.

Battafarano RJ, Piccirillo JF, Meyers BF, Hsu HS, Guthrie TJ, Cooper JD, Patterson GA (2002) Impact of comorbidity on survival after surgical resection in patients with stage I non-small cell lung cancer. J Thorac Cardiovasc Surg 123(2):280–287. https://doi.org/10.1067/mtc.2002.119338CrossRefPubMed

30.

Spicer JD, Brodt P, Ferri LE (2011) The role of inflammation in the early stages of liver metastasis. In: Brodt P (ed) Liver metastasis: biology and clinical management. Springer Science and Business Media, Heidelberg, pp 155–185CrossRef

31.

Teramukai S, Kitano T, Kishida Y, Kawahara M, Kubota K, Komuta K, Minato K, Mio T, Fujita Y, Yonei T, Nakano K, Tsuboi M, Shibata K, Furuse K, Fukushima M (2009) Pretreatment neutrophil count as an independent prognostic factor in advanced non-small-cell lung cancer: an analysis of Japan Multinational Trial Organisation LC00-03. Eur J Cancer 45(11):1950–1958. https://doi.org/10.1016/j.ejca.2009.01.023CrossRefPubMed

32.

Yamanaka T, Matsumoto S, Teramukai S, Ishiwata R, Nagai Y, Fukushima M (2007) The baseline ratio of neutrophils to lymphocytes is associated with patient prognosis in advanced gastric cancer. Oncology 73(3–4):215–220. https://doi.org/10.1159/000127412CrossRefPubMed

33.

Gondo T, Nakashima J, Ohno Y, Choichiro O, Horiguchi Y, Namiki K, Yoshioka K, Ohori M, Hatano T, Tachibana M (2012) Prognostic value of neutrophil-to-lymphocyte ratio and establishment of novel preoperative risk stratification model in bladder cancer patients treated with radical cystectomy. Urology. https://doi.org/10.1016/j.urology.2011.11.070CrossRefPubMed

34.

Spicer JD, McDonald B, Cools-Lartigue JJ, Chow SC, Giannias B, Kubes P, Ferri LE (2012) Neutrophils promote liver metastasis via Mac-1-mediated interactions with circulating tumor cells. Cancer Res 72(16):3919–3927. https://doi.org/10.1158/0008-5472.CAN-11-2393CrossRefPubMed

35.

Kawai T, Akira S (2011) Toll-like receptors and their crosstalk with other innate receptors in infection and immunity. Immunity 34(5):637–650. https://doi.org/10.1016/j.immuni.2011.05.006CrossRefPubMed

36.

Gowing SD, Chow SC, Cools-Lartigue JJ, Chen CB, Najmeh S, Jiang HY, Bourdeau F, Beauchamp A, Mancini U, Angers I, Giannias B, Spicer JD, Rousseau S, Qureshi ST, Ferri LE (2017) Gram-positive pneumonia augments nonsmall cell lung cancer metastasis via host toll-like receptor 2 activation. Int J Cancer. https://doi.org/10.1002/ijc.30734CrossRefPubMed

37.

Kurusu Y, Yamashita J, Ogawa M (1999) Detection of circulating tumor cells by reverse transcriptase-polymerase chain reaction in patients with resectable non-small-cell lung cancer. Surgery 126(5):820–826CrossRef

38.

Sawabata N, Okumura M, Utsumi T, Inoue M, Shiono H, Minami M, Nishida T, Sawa Y (2007) Circulating tumor cells in peripheral blood caused by surgical manipulation of non-small-cell lung cancer: pilot study using an immunocytology method. Gen Thorac Cardiovasc Surg 55(5):189–192. https://doi.org/10.1007/s11748-007-0101-2CrossRefPubMed

Title: Postoperative Adverse Events are Associated with Oncologic Recurrence Following Curative-intent Resection for Lung Cancer
Authors: Stephen Gowing
Laura Baker
Alexandre Tran
Zach Zhang
Hilalion Ahn
Jelena Ivanovic
Caitlin Anstee
Emma Grigor
Sebastien Gilbert
Donna E. Maziak
Farid Shamji
Sudhir Sundaresan
Patrick James Villeneuve
Andrew J. E. Seely
Publication date: 01-12-2020
Publisher: Springer US
Keywords: NSCLC
Lung Cancer
Lung Cancer
NSCLC
Lung Cancer
Published in: Lung / Issue 6/2020
Print ISSN: 0341-2040
Electronic ISSN: 1432-1750
DOI: https://doi.org/10.1007/s00408-020-00395-6

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