Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Exp Med. Mar 20, 2024; 14(1): 89319
Published online Mar 20, 2024. doi: 10.5493/wjem.v14.i1.89319
Predictors of disease recurrence after radical resection and adjuvant chemotherapy in patients with stage IIb-IIIa squamous cell lung cancer: A retrospective analysis
Marina A Senchukova, Evgeniy A Kalinin, Nadezhda N Volchenko
Marina A Senchukova, Department of Oncology, Orenburg State Medical University, Orenburg 460000, Russia
Evgeniy A Kalinin, Department of Thoracic Surgery, Orenburg Regional Cancer Clinic, Orenburg 460021, Russia
Nadezhda N Volchenko, Department of Pathology, P. A. Hertzen Moscow Oncology Research Centre, National Medical Research Centre of Radiology, Moscow 125284, Russia
Author contributions: Senchukova MA designed and performed the research, and wrote the paper; Kalinin EA acquired and analyzed the data and contributed substantially to the conception and design of the study; Volchenko NN participated in the discussion of related data, and revised and approved the final version; all the authors wrote and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by Ethics Committee of Orenburg State Medical University (Russia, Orenburg).
Informed consent statement: Patients were not required to give informed consent to the study because the study was retrospective and analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors have no financial relationships to disclose.
Data sharing statement: Data from patients included in the study in Statistica10 table or Excel table format can be provided upon request to the corresponding author at masenchukova@yandex.com.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marina A Senchukova, MD, PhD, Professor, Department of Oncology, Orenburg State Medical University, Sovetskaya Street, 6, Orenburg 460000, Russia. masenchukova@yandex.com
Received: October 27, 2023
Peer-review started: October 27, 2023
First decision: December 7, 2023
Revised: December 20, 2023
Accepted: January 10, 2024
Article in press: January 10, 2024
Published online: March 20, 2024
Processing time: 143 Days and 23.6 Hours
Abstract
BACKGROUND

Lung cancer (LC) is a global medical, social and economic problem and is one of the most common cancers and the leading cause of mortality from malignant neoplasms. LC is characterized by an aggressive course, and in the presence of disease recurrence risk factors, patients, even at an early stage, may be indicated for adjuvant therapy to improve survival. However, combined treatment does not always guarantee a favorable prognosis. In this regard, establishing predictors of LC recurrence is highly important both for determining the optimal treatment plan for the patients and for evaluating its effectiveness.

AIM

To establish predictors of disease recurrence after radical resection and adjuvant chemotherapy in patients with stage IIb-IIIa lung squamous cell carcinoma (LSCC).

METHODS

A retrospective case-control cohort study included 69 patients with LSCC who underwent radical surgery at the Orenburg Regional Clinical Oncology Center from 2009 to 2018. Postoperatively, all patients received adjuvant chemotherapy. Histological samples of the resected lung were stained with Mayer's hematoxylin and eosin and examined under a light microscope. Univariate and multivariate analyses were used to identify predictors associated with the risk of disease recurrence. Receiver operating characteristic curves were constructed to discriminate between patients with a high risk of disease recurrence and those with a low risk of disease recurrence. Survival was analyzed using the Kaplan-Meier method. The log-rank test was used to compare survival curves between patient subgroups. Differences were considered to be significant at P < 0.05.

RESULTS

The following predictors of a high risk of disease recurrence in patients with stage IIb-IIa LSCC were established: a low degree of tumor differentiation [odds ratio (OR) = 7.94, 95%CI = 1.08-135.81, P = 0.049]; metastases in regional lymph nodes (OR = 5.67, 95%CI = 1.09-36.54, P = 0.048); the presence of loose, fine-fiber connective tissue in the tumor stroma (OR = 21.70, 95%CI = 4.27-110.38, P = 0.0002); and fragmentation of the tumor solid component (OR = 2.53, 95%CI = 1.01-12.23, P = 0.049). The area under the curve of the predictive model was 0.846 (95%CI = 0.73-0.96, P < 0.0001). The sensitivity, accuracy and specificity of the method were 91.8%, 86.9% and 75.0%, respectively. In the group of patients with a low risk of LSCC recurrence, the 1-, 2- and 5-year disease-free survival (DFS) rates were 84.2%, 84.2% and 75.8%, respectively, while in the group with a high risk of LSCC recurrence the DFS rates were 71.7%, 40.1% and 8.2%, respectively (P < 0.00001). Accordingly, in the first group of patients, the 1-, 2- and 5-year overall survival (OS) rates were 94.7%, 82.5% and 82.5%, respectively, while in the second group of patients, the OS rates were 89.8%, 80.1% and 10.3%, respectively (P < 0.00001).

CONCLUSION

The developed method allows us to identify a group of patients at high risk of disease recurrence and to adjust to ongoing treatment.

Keywords: Lung cancer; Lung squamous cell carcinoma; Adjuvant chemotherapy; Radical resection; Disease recurrence risk factors

Core Tip: This study identified the following independent predictors of a high risk of disease recurrence in patients with stage IIb-IIIa lung squamous cell carcinoma treated by radical resection and adjuvant chemotherapy: a low degree of tumor differentiation, metastases in regional lymph nodes, the presence of loose, fine-fiber connective tissue in the tumor stroma and fragmentation of the tumor solid component. The area under the curve of the predictive model was 0.846. The sensitivity, accuracy and specificity of the methods were 91.8%, 86.9% and 75.0%, respectively. The developed method allows us to identify a group of patients at high risk of disease relapse and to adjust the treatment.