Predictive factors for pleural drainage volume after uniportal video-assisted thoracic surgery lobectomy for non-small cell lung cancer: a single-institution retrospective study.

OBJECTIVE: To identify the predictive factors associated with pleural drainage volume (PDV) after uniportal video-assisted thoracic surgery (VATS) lobectomy for non-small cell lung cancer (NSCLC). METHODS: A total of 440 consecutive NSCLC patients who underwent uniportal VATS lobectomy were enrolled in this study between November 2016 and July 2019. Thirty-four parameters, including patients' clinicopathological characteristics and other potential predictors were collected. Daily drainage volume was summed up as PDV. Univariate analysis and multivariate regression models were fitted to identify independent predictive factors for PDV. RESULTS: The median PDV was 840 ml during the median drainage duration of 4 days. A strong correlation was observed between PDV and drainage duration (correlation coefficient = 0.936). On univariate analysis, age, forced expiratory volume in 1 s % predicted (FEV1%), left ventricular ejection fraction (LVEF), operation time, serum total protein (TP), and body mass index (BMI) showed a significant correlation with PDV (P value, < 0.001, < 0.001, 0.003, 0.008, 0.028, and 0.045, respectively). Patients with smoking history (P = 0.030) or who underwent lower lobectomy (P = 0.015) showed significantly increased PDV than never smokers or those who underwent upper or middle lobectomy, respectively. On multivariate regression analysis, older age (P< 0.001), lower FEV1% (P< 0.001), lower LVEF (P = 0.011), lower TP (P = 0.013), and lower lobectomy (P = 0.016) were independent predictors of increased PDV. CONCLUSIONS: Predictive factors of PDV can be identified. Based on these predictors, patients can be treated with tailored individualized safe chest tube management.

The role of plasma D-dimer levels for predicting lymph node and mediastinal lymph node involvement in non-small cell lung cancer.

INTRODUCTION: Elevated plasma D-dimer levels have been suggested as a predictor of poor prognosis in NSCLC. But rare study showed the relationship between D-dimer levels and lymph node involvement. OBJECTIVES: To evaluate the role of plasma D-dimer levels in predicting lymph node and mediastinal lymph node involvement in NSCLC. METHODS: Preoperative plasma D-dimer levels were quantified in 253 NSCLC patients that underwent radical lung resection with systemic lymph node dissection. Patients were classified as lymph node negative (N0) versus lymph node positive (N1 + N2) and mediastinal lymph node negative (N0 + N1) versus mediastinal lymph node positive (N2). RESULTS: Median plasma D-dimer level was significantly lower in Group N0 (94.0 µg/L) compared to Group N1 + N2 (177.0 µg/L) and in Group N0 + N1 (122.0 µg/L) compared to Group N2 (198.0 µg/L). Similar results were found in patients stratified by age, sex, smoking status and histological type, expect in patients with squamous carcinoma. The Receiver Operating Characteristic (ROC) curve for plasma D-dimer levels of N0 versus N1 + N2 showed an area under the curve (AUC) of 0.757 and when a cutoff value was 124.0 µg/L DDU, the sensitivity and specificity was 0.80 and 0.68. The ROC curve for plasma D-dimer levels of N0 + N1 versus N2 showed an AUC of 0.720 and when a cutoff value was 147.0 µg/L DDU, the sensitivity and specificity was 0.75 and 0.67. CONCLUSIONS: Plasma D-dimer level has utility for predicting lymph node and mediastinal lymph node status in patients with operable NSCLC.

Pooled analysis for surgical treatment for isolated adrenal metastasis and non-small cell lung cancer.

OBJECTIVES: This systematic review and pooled analysis investigated outcomes and prognostic factors in Non-small-cell lung cancer (NSCLC) patients who underwent surgical treatment for an isolated adrenal metastasis and the primary NSCLC. METHODS: A literature search of PubMed, Embase and Cochrane Library databases was conducted for relevant retrospective studies in patients with NSCLC and isolated adrenal metastatic lesions treated with lobectomy or pneumonectomy and adrenalectomy. Outcome measures were overall, 1-, 2- and 5-year survival rates stratified by synchronous versus metachronous adrenal metastasis and according to lymph node status, pathology and relative location of the metastasis to the primary tumour. Kaplan-Meier survival curves were generated and differences in survival were assessed by a log-rank test. RESULTS: Thirteen studies involving 98 patients were included in this analysis. The median overall survival was 18 months, and the 1-, 2- and 5-year survival rates were 66.5, 40.5 and 28.2%, respectively. Patients with metachronous adrenal metastasis had a significantly better prognosis than patients with synchronous adrenal metastasis (P < 0.05). Patients classified as negative for lymph node metastasis had a significantly better prognosis than patients classified as positive for lymph node metastasis (P < 0.05). Pathology (squamous carcinoma versus adenocarcinoma) and the relative location of the metastasis to the primary tumour (ipsilateral adrenal metastasis or contralateral adrenal metastasis) had no significant influence on prognosis. CONCLUSIONS: NSCLC patients with isolated adrenal metastasis undergoing surgical treatment for the primary tumour and adrenal metastasis could achieve a significant survival benefit, especially if they have metachronous adrenal metastasis or are negative for lymph node metastasis.