Operative invasiveness does not affect the prognosis of patients with non-small cell lung cancer
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RESEARCH ARTICLE
Open Access
Operative invasiveness does not affect the prognosis of patients with non-small cell lung cancer Nozomu Motono* , Shun Iwai, Yoshihito Iijima, Katsuo Usuda and Hidetaka Uramoto
Abstract Background: The relationship between operative invasiveness and the prognosis in non-small cell lung cancer (NSCLC) patients who have undergone surgery has been controversial. Methods: Clinical data were analyzed for 463 NSCLC patients. Operative invasiveness was defined by wound length, operation time, and the postoperative C-reactive protein (postCRP) level. The operative approach was divided into video-assisted thoracic surgery (VATS) and thoracotomy. Results: The wound length and operation time were significantly correlated with the postCRP level (correlation coefficient (CC) = 0.39, p < 0.01; CC = 0.54, p < 0.01, respectively). The postCRP level in the VATS group was significantly lower than that in the thoracotomy group (12.2 mg/dl vs 20.58 mg/dl, p < 0.01). The relapse-free survival differed significantly based on wound length (p < 0.01), operation time (p = 0.01), CRP level (p < 0.01), and operative approach (p < 0.01). The carcinoembryonic antigen level (hazard ratio [HR], 1.58; p = 0.02), pathological stage (pStage) (HR, 2.57; p < 0.01), vascular invasion (HR, 1.95; p = 0.01), and preoperative CRP level (preCRP) (HR, 1.91; p < 0.01) were identified as significant prognostic factors for relapse-free survival in a multivariate analysis. Furthermore, the multivariate analysis showed that smoking history (HR, 2.36; p = 0.03), pStage (HR, 3.26; p < 0.01), and preCRP level were significant prognostic factors for overall survival. Conclusion: Preoperative CRP level was associated with poor prognosis. Although the VATS approach might be less invasive procedure for NSCLC patients, operative invasiveness does not affect the prognosis. Keywords: Operative invasiveness, Video-assisted thoracic surgery, Non-small cell lung cancer
Background Video-assisted thoracic surgery (VATS) for patients with non-small cell lung cancer (NSCLC) has been widely adopted and the advantages of the VATS approach have been reported [1–7]. These reports have shown that VATS is associated with less pain, a shorter hospital stay, less reduction of the inflammatory-immune response, and the maintenance of the postoperative respiratory function in comparison to thoracotomy. * Correspondence: [email protected] Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa 920-0293, Japan
Furthermore, it was reported that VATS is associated with significantly less response in C-reactive protein (CRP) and cytokine levels. Acute-phase proteins (APPs) are a series of proteins that are sensitive to inflammation and body stress including infection, surgical trauma, certain diseases and tissue damage [8, 9]. The concentrations of certain APPs, including CRP may increase markedly during stress or under pathological conditions. Levels of the CRP increase as a result of the inflammatory response to in
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