RESUMEN
PURPOSE: Atrial fibrillation (Af) is a common post-operative cardiac complication after lung cancer surgery; however, the type of lung cancer surgery being performed has evolved, remarkably, into minimally invasive surgical procedures. The purpose of this study was to quantify the incidence and severity of post-operative Af and to identify the risk factors for Af, using a recent cohort of lung cancer surgery patients. METHODS: We reviewed, retrospectively, the medical records of 593 patients, who underwent lung cancer surgery between 2011 and 2013, for the development of post-operative Af. RESULTS: The overall incidence of post-operative Af in our study was 6.4 % (38/593). Three (8 %) of these 38 patients, subsequently, suffered brain infarction. Multivariate analysis revealed that mediastinal lymph node dissection (OR ND-2/ND-0-1 = 3.06; 95 % CI 1.06-10.9) was associated with the development of post-operative Af. CONCLUSION: Omission of mediastinal lymph dissection for patients with early stage lung cancer and a high risk of Af should be considered to prevent post-operative Af.
Asunto(s)
Fibrilación Atrial/epidemiología , Fibrilación Atrial/etiología , Neoplasias Pulmonares/cirugía , Escisión del Ganglio Linfático/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Adulto , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/prevención & control , Infarto Cerebral/epidemiología , Infarto Cerebral/etiología , Estudios de Cohortes , Contraindicaciones , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Tratamientos Conservadores del Órgano , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Cirugía Torácica Asistida por VideoRESUMEN
PURPOSE: Intratumoral macrophages are reportedly involved in tumor progression in non-small cell lung cancer; however, little is known about the prognostic impact and function of alveolar macrophages (AMs). This study aims to investigate the prognostic impact of the number of peri-tumoral AMs in patients with stage I lung adenocarcinoma. METHODS: We investigated 514 patients with pathological stage I lung adenocarcinoma who underwent complete resection with lobectomy or pneumonectomy. The numbers of peri-tumoral AMs were counted, and patients were classified into two groups based on the number of peri-tumoral AMs. Using the Cancer Genome Atlas (TCGA) database of stage I lung adenocarcinoma, we compared gene expression profiles of high and low peri-tumoral AM contents. RESULTS: The median number of peri-tumoral AMs per alveolar space was 15.5. Patients with a high peri-tumoral AM content had significantly shorter disease-free survival and overall survival than patients with a low peri-tumoral AM content (both p < 0.01). In the multivariate analyses, a higher number of peri-tumoral AMs were an independent prognostic factor (p = 0.02). The analysis of TCGA database revealed that patients with a high peri-tumoral AM content had shorter disease-free survival than those with a low peri-tumoral AM content (p = 0.04). Gene expression analysis of TCGA stage I lung adenocarcinoma revealed enrichment of biological processes, such as chemotaxis and epithelial proliferation, in patients with a high peri-tumoral AM content. CONCLUSION: The number of peri-tumoral AMs had a strong impact on disease-free survival in patients with stage I lung adenocarcinoma.