Gustave Roussy Immune Score based on a three-category risk assessment scale serves as a novel and effective prognostic indicator for surgically resectable early-stage non-small-cell lung cancer: A propensity score matching retrospective cohort study.

BACKGROUNDS: The Gustave Roussy Immune score (GRIm-Score) emerges as a novel prognostic scoring system for patient selection in phase I trials testing targeted immunotherapy for advanced-stage cancer. We tried to assess potential prognostic roles of preoperative GRIm-Score in patients undergoing video-assisted thoracoscopic surgery (VATS) lobectomy for stage I-II non-small-cell lung cancer (NSCLC) by propensity score-matching (PSM) analysis. METHODS: This PSM-based analysis was performed on our single-center prospectively-maintained database between January 2014 and October 2015. A Kaplan-Meier survival analysis using the log-rank test was used to distinguish differences in both overall survival (OS) and disease-free survival (DFS) between the patients stratified by preoperative GRIm-Score. Multivariable Cox-proportional hazards regression analysis and PSM analysis were both carried out to determine the final independent prognostic parameters. RESULTS: There were 405 patients with surgically resectable stage I-II NSCLC included. Both OS and DFS were significantly shortened along with each number increase in the GRIm-Score group, showing a step-wise fashion. Such strong correlations between preoperative GRIm-Score estimated by a modified 3-category risk scale and survival outcomes still remained validated after PSM analysis. In addition, this GRIm-Score held the superior discriminatory power for predicting both OS and DFS to the other peripheral blood biomarkers. Multivariable analyses on the entire cohort and the PSM cohort demonstrated that GRIm-Score based on a 3-category risk assessment scale could be independently predictive of both OS and DFS. CONCLUSIONS: The GRIm-Score tool can also serve as an effective and noninvasive marker to optimize prognostic prediction for surgically resectable stage I-II NSCLC.

[Clinical Effect of Day Surgery in Patients with Lung Caner by Optimize Operating Process].

BACKGROUND: The types and number of day surgery are increasing, what is the result of day surgery of selected patients with lung cancer? To explore the operation process and clinical effect of day surgery in patients with lung cancer by fusing the concept of enhanced recovery after surgery (ERAS) and minimally invasive surgical techniques. METHODS: A prospective study was planned with the approval of our institutional review board. 153 lung cancer patients who underwent anatomic resection in a single medical group between June 2019 and Nov 2019 were randomized. 20 patients were applied day surgery and 28 patients by inpatient surgery and the average length of stay, average hospital cost , complications and adverse reactions were analysed. RESULTS: The average hospital day in DSG group (1 d) was significantly shorter than in ISG group (7.7±2.8) d (P=0.000). The average hospital cost in DSG group (38,297.3±3,408.7)¥ was significantly lower than in ISG group (47,831.1±7,376.1)¥ (P=0.000). There was no significant difference in the incidence of postoperative complications between the daytime surgery group (5.0%) and the inpatient surgery group (3.6%) (P=0.812). The postoperation adverse reactions in DSG (10.0%) and ISG (17.9%) is no difference (P=0.72). CONCLUSIONS: Our study showed that the same clinical effect achieved between DSG and ISG, and recover quickly lung cancer patients after day surgery.

Is surgical Apgar score an effective assessment tool for the prediction of postoperative complications in patients undergoing oesophagectomy?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether the surgical Apgar score (SAS) was an effective assessment tool for the prediction of postoperative complications in patients undergoing oesophagectomy. In total, 7 papers were identified using the reported search, of which 6 cohort studies represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Five of 6 cohort studies demonstrated that a low SAS was significantly associated with more postoperative complications in patients undergoing oesophagectomy. The rates of major individual complications in patients with a lower SAS were commonly higher than those in patients with a higher SAS. Two cohort studies further reported that a low SAS was significantly associated with the prolonged length of stay. The cut-off value of the SAS that had the discriminative power for patients who were considered at high morbidity risk, however, was not defined but was more likely to be 6 or less. Current available evidence suggests that the SAS system may serve as an effective assessment tool for the prediction of morbidity risk after oesophagectomy.

[Impact and Effect of Preoperative Short-term Pulmonary Rehabilitation Training on 
Lung Cancer Patients with Mild to Moderate Chronic Obstructive Pulmonary Disease: 
A Randomized Trial].

BACKGROUND: Pulmonary rehabilitation (PR) is proposed as an effective strategy to decrease surgical morbidity. However, appropriate rehabilitation plan, initiation time, and optimal duration of PR remain unclear. Lung cancer patients with chronic obstructive pulmonary disease (COPD) are considered high-risk population for postoperative pulmonary complications (PPCs) because of poor lung fitness and cardiopulmonary endurance. This study aims to assess the impact of a one-week, systematic and highly-intensive rehabilitation on surgical lung cancer patients with mild to moderate COPD. METHODS: A randomized controlled trial with 48 subjects was conducted (24 patients each for the intervention and groups). The intervention group received seven days of systematic, integrated and highly-intensive PR before surgical treatment, including: pharmacotherapy with atomizing terbutaline, pulmicort and infusion of ambroxol; and physical rehabilitation with respiratory training and endurance training. The control group underwent standard preoperative care. RESULTS: For the intervention group, the postoperative length of stay was shorter [(6.17±2.91) d vs (8.08±2.21) d; P=0.013]; likewise for the duration of antibiotics use [(3.61±2.53) d vs (5.36±3.12) d; P=0.032]. No significant difference was found between the groups in total in-hospital cost [(46,455.6±5,080.9) ¥ vs (45,536.0±4,195.8) ¥, P=0.498], medicine cost [(7,760.3±2,366.0) vs (6,993.0±2,022.5), P=0.223], and material cost [(21,155.5±10,512.1) ¥ vs (21,488.8±3,470.6) ¥, P=0.883]. In the intervention group, peak expiratory flow [(268.40±123.94) L/min vs (343.71±123.92) L/min; P<0.001], 6-min walk distance (6-MWD) [(595.42±106.74) m vs (620.90±99.27) m; P=0.004], and energy consumption [(59.93±10.61) kcal vs (61.03±10.47) kcal; P=0.004] were statistically different after the seven-day exercise, compared with those on the first day. Finally, for the intervention group the incidence of PPCs (8.3%, 2/24 vs 20.8%, 5/24, 20.8%; P=0.416) were lower. CONCLUSIONS: The systematic and highly-intensive pulmonary rehabilitation combining abdominal respiration training, respiratory exercise with incentive spirometry, and aerobic exercise could improve the cardiorespiratory endurance of lung cancer patients with mild to moderate COPD. The proposed program may be a practicable preoperative strategy.
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[Influencing factor of postoperation fast-track recovery and in hospital cost after lobctomy for lung cancer].

BACKGROUND: It is unknown that the postoperation fast-track recovery and in hospital cost of the lobectomy in lung cancer, we explored the influencing factor of postoperative fast-track recovery and in hospital cost after undergoing lobectomy for lung cancer. METHODS: We retrospectively reviewed the medical records of all patients (n=176) who underwent lobectomy for lung cancer between January 2010 and November 2011 by a thoracic surgeon. RESULTS: The hospital costs of video-assisted thoracic surgery (VATS) lobectomy (47,308.21 ¥) is significantly higher than open lobectomy (45,664.31 ¥)(P=0.007). The hospital costs of body mass index (BMI) ≥ 24 kg/m2 (51,186.99 ¥) is significantly higher than BMI < 24 kg/m2 (41,701.64 ¥)(P=0.032). The hospital stay of VATS lobectomy (5.70 d) is significantly less than open lobectomy (7.10 d)(P<0.001). CONCLUSIONS: These findings indicate that preoperative pulmonary rehabilitation and VATS lobectomy is contributed to fast-track recovery for patients who undergo lobectomy, but increase the hospital costs.