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Research article
Nozomu Motono
Kanazawa Medical University
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5407-5479
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This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Pulmonary Medicine.
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
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Editorial decision: Minor revision
On 12 Aug, 2020
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On 10 Aug, 2020
Submission checks complete
On 09 Aug, 2020
Editor invited
On 09 Aug, 2020
No comments provided
Editorial decision: Minor revision
On 04 Aug, 2020
Editor assigned
On 27 Jul, 2020
Submission checks complete
On 26 Jul, 2020
Editor invited
On 26 Jul, 2020
No comments provided
Editorial decision: Minor revision
On 24 Jul, 2020
Review #1 received
Received 23 Jul, 2020
Reviewer #3 agreed
On 05 Jul, 2020
Reviewer #2 agreed
On 04 Jul, 2020
Review #2 received
Received 04 Jul, 2020
Reviewer #1 agreed
On 02 Jul, 2020
Editor assigned
On 01 Jul, 2020
Reviewers invited
Invitations sent on 01 Jul, 2020
Submission checks complete
On 30 Jun, 2020
Editor invited
On 30 Jun, 2020
No comments provided
Editorial decision: Major revision
On 26 Jun, 2020
Review #1 received
Received 23 Jun, 2020
Review #2 received
Received 18 Jun, 2020
Review #3 received
Received 18 Jun, 2020
Reviewer #2 agreed
On 04 Jun, 2020
Reviewer #3 agreed
On 04 Jun, 2020
Reviewer #1 agreed
On 02 Jun, 2020
Editor assigned
On 30 May, 2020
Reviewers invited
Invitations sent on 30 May, 2020
Submission checks complete
On 29 May, 2020
Editor invited
On 29 May, 2020
First submitted
On 27 May, 2020
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Pulmonology
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This preprint is under consideration at BMC Pulmonary Medicine. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Nozomu Motono
Kanazawa Medical University
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5407-5479
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 5
Posted 18 Aug, 2020
No comments provided
Editorial decision: Minor revision
On 12 Aug, 2020
Editor assigned
On 10 Aug, 2020
Submission checks complete
On 09 Aug, 2020
Editor invited
On 09 Aug, 2020
No comments provided
Editorial decision: Minor revision
On 04 Aug, 2020
Editor assigned
On 27 Jul, 2020
Submission checks complete
On 26 Jul, 2020
Editor invited
On 26 Jul, 2020
No comments provided
Editorial decision: Minor revision
On 24 Jul, 2020
Review #1 received
Received 23 Jul, 2020
Reviewer #3 agreed
On 05 Jul, 2020
Reviewer #2 agreed
On 04 Jul, 2020
Review #2 received
Received 04 Jul, 2020
Reviewer #1 agreed
On 02 Jul, 2020
Editor assigned
On 01 Jul, 2020
Reviewers invited
Invitations sent on 01 Jul, 2020
Submission checks complete
On 30 Jun, 2020
Editor invited
On 30 Jun, 2020
No comments provided
Editorial decision: Major revision
On 26 Jun, 2020
Review #1 received
Received 23 Jun, 2020
Review #2 received
Received 18 Jun, 2020
Review #3 received
Received 18 Jun, 2020
Reviewer #2 agreed
On 04 Jun, 2020
Reviewer #3 agreed
On 04 Jun, 2020
Reviewer #1 agreed
On 02 Jun, 2020
Editor assigned
On 30 May, 2020
Reviewers invited
Invitations sent on 30 May, 2020
Submission checks complete
On 29 May, 2020
Editor invited
On 29 May, 2020
First submitted
On 27 May, 2020
Subject Areas
Pulmonology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Pulmonary Medicine.
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.
Figure 1
Figure 2
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