nach oben

World Journal of Surgical Oncology

Erschienen in:

Open Access 01.12.2023 | Research

A combined preoperative red cell distribution width and carcinoembryonic antigen score contribute to prognosis prediction in stage I lung adenocarcinoma

verfasst von: Hengliang Xu, Guangqiang Zhao, Jixing Lin, Qianwen Ye, Jia Xiang, Bing Yan

Erschienen in: World Journal of Surgical Oncology | Ausgabe 1/2023

Abstract

Aims

Hematological markers that can be used for prognosis prediction for stage I lung adenocarcinoma (LUAD) are still lacking. Here, we examined the prognostic value of a combination of the red cell distribution width (RDW) and carcinoembryonic antigen (CEA), namely, the RDW-CEA score (RCS), in stage I LUAD.

Materials and methods

A retrospective study with 154 patients with stage I LUAD was conducted. Patients were divided into RCS 1 (decreased RDW and CEA), RCS 2 (decreased RDW and increased CEA, increased RDW and decreased CEA), and RCS 3 (increased RDW and CEA) subgroups based on the best optimal cutoff points of RDW and CEA for overall survival (OS). The differences in other clinicopathological parameters among RCS subgroups were calculated. Disease-free survival (DFS) and OS among these groups were determined by Kaplan–Meier analysis, and risk factors for outcome were calculated by a Cox proportional hazards model.

Results

Seventy, 65, and 19 patients were assigned to the RCS 1, 2, and 3 subgroups, respectively. Patients ≥ 60 years (P < 0.001), male sex (P = 0.004), T₂ stage (P = 0.004), and IB stage (P = 0.006) were more significant in the RCS 2 or 3 subgroups. The RCS had a good area under the curve (AUC) for predicting DFS (AUC = 0.81, P < 0.001) and OS (AUC = 0.93, P < 0.001). The DFS (log-rank = 33.26, P < 0.001) and OS (log-rank = 42.05, P < 0.001) were significantly different among RCS subgroups, with RCS 3 patients displaying the worst survival compared to RCS 1 or 2 patients. RCS 3 was also an independent risk factor for both DFS and OS.

Conclusions

RCS is a useful prognostic indicator in stage I LUAD patients, and RCS 3 patients have poorer survival. However, randomized controlled trials are needed to validate our findings in the future.

Hengliang Xu, Guangqiang Zhao, and Jixing Lin contributed equally to this work.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Introduction

Lung cancer is still the leading cause of cancer-related death worldwide, with an estimated 1.8 million deaths in 2020 [1]. Fortunately, with the increasing popularity of low-dose computed tomographic screening, the mortality of the disease has decreased remarkably in recent years, and patients can be treated at early stages [2, 3]. However, recurrence is frustratingly unavoidable, and the 5-year overall survival (OS) rates are 68–92% for stage I cases according to the eighth edition of the Tumor-Node-Metastasis (TNM) classification [4]. Reliable prognostic markers that can be used for these early patients are still needed.

Previously, except for the risk factors identified in the National Comprehensive Cancer Network guidelines for non-small cell lung cancer (NSCLC) [5] and pathologically micropapillary and solid patterns [6], tumor spread through air spaces [7] is regarded as an additional risk factor for stage I cases, and patients with these features are thought to be candidates to receive and benefit from adjuvant therapies (ADTs). However, hematological markers, which can be easily obtained from routine blood tests that could also guide the treatment for these patients, are still lacking. Red cell distribution width (RDW), which can reflect the size heterogeneity of circulating erythrocytes, was also found to be associated with inflammation, malnutrition, and impaired kidney function [8]. The prognostic value of RDW has been registered in many cancers according to a meta-analysis [9]. In lung cancer, Wang et al. conducted a meta-analysis and indicated that a higher value of pretreatment RDW was significantly associated with worse OS and disease-free survival (DFS) [10]; however, single RDW was less efficient in predicting the outcome since the reported area under the curve (AUC) ranged from 0.565 [11] to 0.629 [12, 13]. Additionally, these studies conventionally included stage I–IV cases, which may have greatly biased the results [11‐13]. To date, only two studies have explored the prognostic value of RDW in stage I lung cancer [14, 15]; however, without reporting the definite AUC, more studies are still needed.

Carcinoembryonic antigen (CEA) is a tumor maker in NSCLC [16], and its prognostic value is under extensive study [17]. However, the positive rate of CEA is still limited (ranging from 19 to 33.6% [18‐20]) in stage I cases, and its prognostic value is under debate in such a scenario. For example, Kuo et al. conducted a study with 758 stage I patients (541 adenocarcinomas (AD), 83 squamous cell carcinomas (SCC), and 134 others) and found that CEA was an independent risk factor for recurrence [21]. However, Blankenburg et al. conducted a study with 240 stage I NSCLC patients (91 AD, 100 SCC, and 32 others) and found that preoperative CEA could not be used to predict the 3- or 5-year OS with a cutoff value of 6.7 ng/mL [22]; in line with this, Maeda et al. performed a study that enrolled 229 stage IA patients (195 AD, 34 others) and suggested that preoperative CEA was not an independent risk factor for poor prognosis [23]. Nonetheless, it was notable that CEA was much more efficient in AD than other pathological phenotypes [24, 25] in NSCLC, and the majority of previous studies mixed with other pathological phenotypes could attenuate the prognostic efficacy of CEA. Interestingly, some authors have tried to combine hematological markers, such as platelets, with CEA to further improve its prognostic efficacy in NSCLC [26], and other studies have indicated that a combination of RDW with tumor markers would be useful for the prognosis of cancer patients [27, 28]. Based on these findings, we speculated that a combination of RDW and CEA could also be meaningful in the prognosis of stage I lung adenocarcinoma (LUAD); however, related reports are rare.

Here, we aimed to explore the prognostic value of a newly established indicator, namely, the combined RDW and CEA score (RCS), in stage I LUAD.

Materials and methods

Patients

From December 2012 to April 2019, data from patients who underwent surgery for lung cancer at Hainan Hospital of Chinese PLA General Hospital were retrospectively collected. Those who met any one of the following criteria were excluded: (1) suspected distant lesions by preoperative examinations, (2) any preoperative adjuvant therapies, (3) in situ lesions, (4) lack of preoperative laboratory tests, (5) lack of any pathological TNM (pTNM) information, (6) pTNM > I according to the 8th edition of AJCC [4], (7) pathological phenotypes other than AD, and (8) follow-up problems. Other parameters, including age, sex, type of resection, and others, were also recorded as in our previous reports [29, 30]. The study was performed in line with the principles stated in the Declaration of Helsinki and was supervised by the ethics committee of Hainan Hospital of Chinese PLA General Hospital. Written informed consent was waived due to its retrospective nature.

Defining RCS and other inflammatory prognostic indicators

The data from routine blood tests were obtained within 1 week before curative surgery as previously described [29, 30]. CEA measurement was conducted in automated Cobas e601 immunoanalyzer (Roche Diagnostics GmbH, Germany) using an electrochemiluminescence immunoassay method with a reference at 0–5.0 ng/mL. Patients were divided into RDW-low or RDW-high and CEA-low or CEA-high subgroups based on the optimal cutoff points in the statistical results below. Subsequently, patients were divided into 3 subgroups, namely, RCS 1: both decreased RDW and CEA; RCS 2: decreased RDW with increased CEA or increased RDW with decreased CEA; and RCS 3: both increased RDW and CEA. Other inflammatory prognostic indicators, including the other systematic inflammatory prognostic indicators, including the neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), prognostic nutritional index (PNI), and advanced lung cancer inflammation index (ALI), were determined as described in previous studies [31‐33].

Follow-up and definition of DFS and OS

Patients were routinely followed according to our previous studies [30]. DFS was defined as the date of surgery to the point of any recurrence, metastasis, or death from any cause, and OS was defined from the identical point to the point of any cause of death. The latest follow-up point ended in March 2022.

Statistical analysis

All analyses were conducted by SPSS 20.0 (SPSS Inc., Chicago, IL, USA) and GraphPad Prism 5 (GraphPad Software Inc., San Diego, CA, USA). The optimal cutoff points of RDW and CEA for the outcome were tested by receiver operating characteristic curve (ROC) analysis. The differences in NLR, LMR, PNI, and ALI in RCS subgroups were analyzed by one-way ANOVA (with LSD for pairwise comparison) or nonparametric tests if a Gaussian distribution was not reached. Survival differences among RCS subgroups were measured by Kaplan–Meier analysis. Risk factors for survival were determined by a Cox proportional hazards model with the iterative forward LR method. P < 0.050 was considered statistically significant.

Results

Demographic characteristics of the cohort and the efficacy of RCS in prognosis

In total, 325 patients were included with 30 patients presenting distant lesions; in addition, 141 patients were excluded according to the exclusion criteria (Fig. 1). One hundred fifty-four patients were enrolled in the final cohort, with 124 IA and 30 IB cases. The ratio of female to male was 1:1 (n = 77 each), and the median follow-up was 49 months (m) (range: 9–118 m). During the follow-up, 16 patients experienced recurrence, and 8 patients died. By ROC analysis, the RCS was significant in predicting both DFS (AUC = 0.81, P < 0.001) and OS (AUC = 0.93, P < 0.001), and the AUC was larger than that of RDW or CEA alone (Fig. 2).

The differences in clinicopathological features among RCS subgroups

Taking OS as the end-point, the optimal cutoff points of RDW and CEA to the outcome were determined, and patients were divided into increased (≥ 13.45%) or decreased (< 13.45%) RDW and increased (≥ 1.20 ng/mL) or decreased (< 1.20 ng/mL) CEA subgroups. Based on these results, patients were divided into RCS 1 (n = 70, median age: 51 years, range: 29–72 years), RCS 2 (n = 65, median age: 60 years, range: 23–79 years), and RCS 3 (n = 19, median age: 65 years, range: 49–71 years) subgroups (Fig. 3). It was found that features such as ≥ 60 years (P < 0.001), male sex (P = 0.004), current or former tobacco use history (P = 0.001), T₂ stage (P = 0.004), and IB stage (P = 0.006) were more significant in the RCS 2 or 3 subgroups (Table 1).

Table 1

Differences of the clinicopathological features in RCS subgroups

Features	Patient No	RCS
		RCS 1	RCS 2	RCS 3	P
Age (years)					< 0.001^*
< 60	90	52	33	5
≥ 60	64	18	32	14
Gender					0.004^*
Male	77	25	39	13
Female	77	45	26	6
Type of resection					0.788
Lobectomy	114	50	50	14
Segmentectomy	40	20	15	5
Micropapillary or solid component					0.830
Without or unknown	120	56	50	14
With	34	14	15	5
Tobacco use history					0.001^*
Never	119	63	45	11
Current + former	35	7	20	8
Alcohol use history					0.972
Never	100	45	43	12
Current + former	54	25	22	7
Hypertension					0.060
Without	119	60	45	14
With	35	10	20	5
Combined T stages					0.004^*
T₁	123	63	49	11
T₂	31	7	16	8
TNM stages					0.006^*
IA	124	63	50	11
IB	30	7	15	8

^*With significant statistical difference

No Number, RCS Red cell distribution width and carcinoembryonic antigen score, TNM Tumor-Node-Metastasis

Correlation of RCS with other systematic inflammatory indicators

As shown in Fig. 4, significant differences were found for NLR, LMR, PNI, and ALI among the different RCS subgroups. In general, a significantly higher NLR was found between the RCS 3 and RCS 2 or 1 subgroups, whereas a significantly lower LMR, PNI, and ALI were also found between the RCS 3 and 1 subgroups and a significantly lower ALI was found between the RCS 3 and 2 subgroups.

Survival differences among RCS subgroups

By Kaplan–Meier analysis, significant differences in DFS and OS were found among the different RCS subgroups (Fig. 5). Specifically, patients with different RCS could be well separated individually in DFS (the 3-year DFS rates in RCS 1, 2, and 3 were 98.57%, 93.84%, and 63.16%, respectively, P < 0.001); however, RCS 2 patients displayed an improved OS, which was similar to RCS 1 patients without a significant difference.

Univariate and multivariate analysis of risk factors for survival

By the Cox hazard model, with or without micropapillary or solid components, tobacco use history and RCS subgroups were identified as risk factors for both DFS and OS; in addition, with or without hypertension was a risk factor for DFS and TNM stage was a risk factor for OS (Table 2). When these factors were put into multivariate analysis, RCS was found to be an independent risk factor for both DFS and OS (Table 3).

Table 2

Univariate tests for risk factors for DFS or OS

	DFS			OS
	P	HR	95%CI	P	HR	95%CI
Age (years)
< 60	1			1
≥ 60	0.097	2.32	0.87–5.76	0.078	4.21	0.85–20.87
Gender
Male	1			1
Female	0.187	0.52	0.19–1.38	0.215	0.36	0.07–1.80
Type of resection
Lobectomy	1			1
Segmentectomy	0.635	1.36	0.39–4.77	0.650	1.64	0.19–13.88
Micropapillary or solid component
Without or unknown	1			1
With	0.014^*	3.20	1.26–8.13	0.014^*	6.04	1.44–25.27
Tobacco use history
Never	1			1
Current + former	0.001^*	5.10	2.01–12.96	0.010^*	6.59	1.57–27.68
Alcohol use history
Never	1			1
Current + former	0.351	1.56	0.61–3.95	0.829	1.17	0.28–4.91
Hypertension
Without	1			1
With	0.029^*	2.83	1.12–7.17	0.872	1.14	0.23–5.65
Combined T stages
T₁	1			1
T₂	0.097	2.32	0.87–5.76	0.097	2.32	0.87–5.76
TNM stages
IA	1			1
IB	0.094	2.32	0.87–6.21	0.027^*	4.84	1.20–19.58
RCS subgroups
1 + 2	1			1
3	< 0.001^*	8.64	3.42–21.79	< 0.001^*	50.21	6.17–408.60

^*With significant statistical difference

DFS Disease-free survival, OS Overall survival, HR Hazard ratio, CI Confidence interval, RCS Red cell distribution width and carcinoembryonic antigen score, TNM Tumor-Node-Metastasis

Table 3

Multivariate tests for risk factors for DFS or OS

	DFS			OS
	P	HR	95%CI	P	HR	95%CI
Micropapillary or solid component
Without or unknown	1			1
With	0.047^*	2.69	1.01–7.16	0.035^*	4.74	1.12–20.11
Tobacco use history
Never	1
Current + former	0.003^*	4.44	1.66–11.91
RCS subgroups
1 + 2	1			1
3	< 0.001^*	7.74	2.98–20.08	< 0.001^*	44.69	5.47–365.29

^*With significant statistical difference

DFS Disease-free survival, OS Overall survival, HR Hazard ratio, CI Confidence interval, RCS Red cell distribution width and carcinoembryonic antigen score

Discussion

In the present study, RCS was found to be a useful prognostic marker in stage I LUAD and could effectively separate the DFS among these patients. RCS 3 patients had worse outcomes than RCS 1 and RCS 2 patients, and it was an independent risk factor for survival. To the best of our knowledge, this is the first study concerning the utility of RCS in lung cancer.

The prognostic value of RDW and CEA has been registered in lung cancer previously. For RDW, Wang et al. conducted a meta-analysis that indicated that pretreatment RDW was significantly associated with poor DFS and OS [10]. However, it was notable that most of the studies enrolled imbalanced stages or mixed pathological phenotypes, and the prognostic value of RDW was likely to be more apparent in early-stage AD cases. For example, Liu et al. conducted a study with 750 stage I–III patients (stage I: n = 352, stage II: n = 134, stage III: n = 264) to explore the prognostic value of RDW, with more than half of the cases being AD (401/750) [34]. Matsui et al. also performed a study with 338 stage I–III patients (stage I: n = 289, stage II: n = 44, stage III: n = 5), and up to 70.38% of the cases were AD (259/338) [35]. To date, only two studies have reported the prognostic value of RDW (226 AD, 47 others [14]; 166 AD [15]) in stage I NSCLC. Moreover, the AUC of RDW alone in predicting survival has been relatively small [11‐13]. These results indicated that further improvement of the prognostic efficacy is needed when explored in a specific stage or pathological phenotype. CEA was a useful tumor marker in lung cancer. Interestingly, the prognostic value of CEA in stage I cases has been extensively studied [36, 37]. However, the positive rate of CEA was higher in AD than other pathological phenotypes [24, 25], but similar to RDW, previous studies did not specifically explore its value in AD in stage I cases. In our study, we concurrently explored the prognostic value of RDW and CEA in stage I AD patients, and the results indicated that RCS displayed a larger AUC than RDW and CEA in predicting the outcome. Interestingly, a previous study also investigated the value of a combination of other hematological index (platelet, PLT) with CEA in NSCLC (stage I: n = 193, stage II + III: n = 83), and the results indicated that the survival was different when patients were divided into PLT^normal/CEA^normal, PLT^normal/CEA^high, PLT^high/CEA^normal, and PLT^high/CEA^high subgroups; however, it was also notable that such algorithm cannot separate the survival effectively in some subgroups [26]. In addition, although not conducted in NSCLC, other studies have indicated that a combination of RDW with tumor markers (CA125 in endometrial cancer [27]; CEA in colorectal cancer [28]) could have better efficacy in prognosis than used individually. Our study finds that RCS could be better in prognostic prediction and could separate the DFS effectively in stage I LUAD; additionally, RCS could be used to identify a cluster of patients with significant inferior OS.

Mechanistically, cancer-related inflammation is thought to be the seventh hallmark of cancer and plays a profound role in cancer initiation and development [38, 39]; in turn, cancer cells can also promote self-development by secreting inflammatory cytokines in an autocrine manner [40]. In lung cancer, some cytokines were significantly elevated in patients, such as interleukin-6 (IL-6) [41, 42], which has broad functions in regulating cancer cells. For example, IL-6 can promote cell proliferation [43], metastasis, and epithelial-mesenchymal transition (EMT) [44]; it can also contribute to treatment (cisplatin [45], EGF receptor (EGFR) tyrosine kinase inhibitors (TKIs) [46]) resistance. Many studies have indicated that abnormally elevated IL-6 predicts poor survival in lung cancer [41, 42, 47]. Interestingly, systematic evaluation of IL-6 can also result in a fluctuation of RDW, as an increase or decrease in RDW was closely correlated with high or low levels of IL-6, although not in the cancer background [48, 49]. In addition, the counts of circulating tumor cells (CTCs) were found to play an essential role in disease recurrence or metastasis in a postoperative setting [50, 51], and these cells were also found to be a major source of CEA in patients [52, 53]. Importantly, some CTCs share the characteristics of cancer stem cells (CSCs) [54, 55], which were identified as the ultimate source of cancer recurrence, metastasis, and treatment resistance [56, 57]. IL-6 can additionally amplify these cells, except for the aforementioned function in cancer cells [43‐46]. Based on these findings, RCS 1 patients could mean a decreased concentration of IL-6 and low counts of CTCs or CSCs and also a low mutual promotion between them, which could have a superior outcome than the RCS 2 or 3 patients. Additionally, the prognostic value of other parameters including age [58], gender [58], micropapillary and solid patterns [6], type of resection [58, 59], and smoke and alcohol [60] have been under extensive study in stage I lung cancer, and hypertension was also found contribute to prognosis in lung cancer [61]. It was suggested that male patients smoke in particular after diagnosis correlated with poor survival in stage I cases [58, 60]. In our study, the proportion of male (25/70) and smoke (current + former) (7/70) in the RCS 1 group was significantly lower than in the RCS 2 and 3 subgroups, which may partly support its positive role in survival. Except these, although a high proportion of patients < 60 years was noted in the RCS 1 group in contrast to other subgroups; however, a great number of previous studies indicated that age was not a risk factor for survival in stage I lung cancer patients [62‐64]. It was not definite to conclude that age plays a synergic role for good survival in the RCS 1 group at present. Interestingly, we also found a significant difference in other inflammatory prognostic indicators between RCS subgroups, as RCS 1 patients presented the highest NLR and lowest LMR, PNI, and ALI. Although it has not been extensively studied in stage I cases, the low levels of LMR [65], PNI [66], and ALI [67] have been found to be correlated with poor survival in patients after surgery, whereas the high level of NLR was found to be correlated with poor prognosis specifically in stage I cases [68]. These findings also support the notion that RCS 1 patients would have superior survival in our study.

Interestingly, RCS 2 included two subgroups of patients with a reversed increase or decrease in RDW or CEA and displayed a significantly poorer DFS but a similar OS compared with the RCS 1 subgroup. This could also be interpreted from the cancer-related inflammation and CTC perspectives. For DFS, the RCS 2 patients had relatively low levels of IL-6 with a high CTC count or vice versa. For the former, the high count of CTCs was a well-validated poor prognostic indicator in previous studies [50, 51]; for the latter, the CTCs could potentially quickly proliferate with the support of IL-6 [43], both of which could result in an early recurrence or metastasis in contrast to RCS 1 patients. For OS, the subsequent treatment after recurrence or metastasis should be taken into consideration. Notably, more than half of LUAD patients in China harbor EGFR mutations [69, 70], particularly females (66.67% in RCS 2 cases in our study) and never smokers (55.56% in RCS 2 cases in our study) [71, 72], and these patients are commonly treated with TKIs. Notably, it was found that treatment by TKIs such as gefitinib could lead to an obvious decrease in IL-6 in the patients [73]; in addition, such treatment could also shift a portion of patients with high counts of CTCs into low ones, which could have a significantly prolonged PFS [74], which is a surrogate for OS in NSCLC [75]. In addition, we noticed that RCS 3 patients displayed the worst DFS and OS in the cohort, even given that these patients have the same probability of harboring EGFR mutations and undergoing subsequent TKI treatment. We speculate that these patients may have a persistent expansion of CTCs, which could be promoted by a systematic-autocrine IL-6 loop [43] or a shift to the stemness feature of CTCs with IL-6 [76]. Clinically, adjuvant therapies (ADTs) (including chemotherapy, TKIs, or immunotherapy) were still not recommended for stage IA patients and were still controversial in stage IB cases. Based on our results, it was plausible that RCS 1 cases could be waived from ADTs safely due to the outstanding outcome, in addition, although RCS 2 patients were candidates for ADTs due to the relatively poor DFS; however, it was notable that the 3-year absolute benefits from such therapies (taken chemotherapy for example) was only 3.9% and the proportion of 3–4 grade adverse effects was up to 66% [77]; we thus believed “watch and wait” may also be an alternative option for these patients. RCS 3 patients presented the worst DFS and OS in our study, which indicated that these patients were candidates for ADTs and also receive more effective regimens, such as the additional agents anti-IL-6 (ALD518 [78] or siltuximab [79]), in addition to TKIs or TKIs plus chemotherapy based on our aforementioned speculation.

There are certain limitations to the present study. First, it was a retrospective study performed in a single hospital, and the sample size was relatively limited; in particular, only 19 patients were assigned to the RCS 3 group, which could bias the results. Second, the information of gene testing and the subsequent therapy regimens were not definite in our cohort, which therefore could not support our speculation. Some evidence for our speculation could be obtained if post hoc analysis could be conducted like the LACE study [77] where RCS could be analyzed as a stratification factor. Third, as pure solid type could have different CTCs in NSCLC [80], we could not analyze the pathological phenotype to the prognosis since 30 patients did not report definite pathological elements in resected samples. Fourth, taking into account the fact that RDW and CEA could be easily measured during subsequent treatment or follow-up, repeated assessments to validate its prognostic value in stage I LUAD are achievable. Nonetheless, more studies with a large sample size, in particular the randomized controlled trials, are the best way to validate our findings in the future.

Conclusion

Overall, our study indicated that RCS was a useful prognostic marker in stage I LUAD patients and RCS 3 patients had the worst survival. In addition, taking into account the fact that the poor OS in RCS 3 patients, we speculate that more effective ADTs should be an option for these patients; however, randomized controlled trials are needed in the future.

Acknowledgements

None.

Declarations

The study was performed in line with the principles stated in the Declaration of Helsinki and was supervised by the ethics committee of Hainan Hospital of Chinese PLA General Hospital. Written informed consent was waived due to its retrospective nature.

Not applicable.

Competing interests

The authors declare no competing interests.

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49.CrossRefPubMed

National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395–409.CrossRef

Gierada DS, Pinsky PF. Survival following detection of stage I lung cancer by screening in the national lung screening trial. Chest. 2021;159(2):862–9.CrossRefPubMed

Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WE, et al. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (Eighth) edition of the TNM classification for lung cancer. J Thorac Oncol. 2016;11(1):39–51.CrossRefPubMed

Ettinger DS, Wood DE, Aisner DL, Akerley W, Bauman JR, Bharat A, et al. NCCN guidelines insights: non-small cell lung cancer, version 2.2021. J Natl Compr Canc Netw. 2021;19(3):254–66.CrossRefPubMed

Peng B, Li G, Guo Y. Prognostic significance of micropapillary and solid patterns in stage IA lung adenocarcinoma. Am J Transl Res. 2021;13(9):10562–9.PubMedCentralPubMed

Chen D, Wang X, Zhang F, Han R, Ding Q, Xu X, et al. Could tumor spread through air spaces benefit from adjuvant chemotherapy in stage I lung adenocarcinoma? A multi-institutional study. Ther Adv Med Oncol. 2020;12:1758835920978147.PubMedCentralCrossRefPubMed

Montagnana M, Danese E. Red cell distribution width and cancer. Ann Transl Med. 2016;4(20):399.PubMedCentralCrossRefPubMed

Wang PF, Song SY, Guo H, Wang TJ, Liu N, Yan CX. Prognostic role of pretreatment red blood cell distribution width in patients with cancer: a meta-analysis of 49 studies. J Cancer. 2019;10(18):4305–17.PubMedCentralCrossRefPubMed

10.

Wang Y, Zhou Y, Zhou K, Li J, Che G. Prognostic value of pre-treatment red blood cell distribution width in lung cancer: a meta-analysis. Biomarkers. 2020;25(3):241–7.CrossRefPubMed

11.

Kos M, Hocazade C, Kos FT, Uncu D, Karakas E, Dogan M, et al. Evaluation of the effects of red blood cell distribution width on survival in lung cancer patients. Contemp Oncol (Pozn). 2016;20(2):153–7.PubMed

12.

Peng H, Tan X, Wang Y, Dai L, Liang G, Guo J, et al. Clinical Significance of red cell distribution width and circulating tumor cells with an epithelial-mesenchymal transition phenotype in lung adenocarcinoma. Cancer Manag Res. 2020;12:5105–17.PubMedCentralCrossRefPubMed

13.

Chen JL, Wu JN, Lv XD, Yang QC, Chen JR, Zhang DM. The value of red blood cell distribution width, neutrophil-to-lymphocyte ratio, and hemoglobin-to-red blood cell distribution width ratio in the progression of non-small cell lung cancer. PLoS ONE. 2020;15(8):e0237947.PubMedCentralCrossRefPubMed

14.

Toyokawa G, Shoji F, Yamazaki K, Shimokawa M, Takeo S. Significance of the red blood cell distribution width in resected pathologic stage I nonsmall cell lung cancer. Semin Thorac Cardiovasc Surg. 2020;32(4):1036–45.CrossRefPubMed

15.

Kobayashi S, Karube Y, Inoue T, Araki O, Maeda S, Matsumura Y, et al. Advanced lung cancer inflammation index predicts outcomes of patients with pathological stage IA lung adenocarcinoma following surgical resection. Ann Thorac Cardiovasc Surg. 2019;25(2):87–94.CrossRefPubMed

16.

Okamura K, Takayama K, Izumi M, Harada T, Furuyama K, Nakanishi Y. Diagnostic value of CEA and CYFRA 21–1 tumor markers in primary lung cancer. Lung Cancer. 2013;80(1):45–9.CrossRefPubMed

17.

Jiao Z, Cao S, Li J, Hu N, Gong Y, Wang L, et al. Clinical associations of preoperative and postoperative serum CEA and lung cancer outcome. Front Mol Biosci. 2021;8:686313.PubMedCentralCrossRefPubMed

18.

Sawabata N, Ohta M, Takeda S, Hirano H, Okumura Y, Asada H, et al. Serum carcinoembryonic antigen level in surgically resected clinical stage I patients with non-small cell lung cancer. Ann Thorac Surg. 2002;74(1):174–9.CrossRefPubMed

19.

Matsuoka K, Sumitomo S, Nakashima N, Nakajima D, Misaki N. Prognostic value of carcinoembryonic antigen and CYFRA21-1 in patients with pathological stage I non-small cell lung cancer. Eur J Cardiothorac Surg. 2007;32(3):435–9.CrossRefPubMed

20.

Kawachi R, Nakazato Y, Takei H, Koshi-ishi Y, Goya T. Clinical significance of preoperative carcinoembryonic antigen level for clinical stage I non-small cell lung cancer: can preoperative carcinoembryonic antigen level predict pathological stage? Interact Cardiovasc Thorac Surg. 2009;9(2):199–202.CrossRefPubMed

21.

Kuo SW, Chen JS, Huang PM, Hsu HH, Lai HS, Lee JM. Prognostic significance of histologic differentiation, carcinoembryonic antigen value, and lymphovascular invasion in stage I non-small cell lung cancer. J Thorac Cardiovasc Surg. 2014;148(4):1200-7.e3.CrossRefPubMed

22.

Blankenburg F, Hatz R, Nagel D, Ankerst D, Reinmiedl J, Gruber C, et al. Preoperative CYFRA 21–1 and CEA as prognostic factors in patients with stage I non-small cell lung cancer: external validation of a prognostic score. Tumour Biol. 2008;29(4):272–7.CrossRefPubMed

23.

Maeda R, Suda T, Hachimaru A, Tochii D, Tochii S, Takagi Y. Clinical significance of preoperative carcinoembryonic antigen level in patients with clinical stage IA non-small cell lung cancer. J Thorac Dis. 2017;9(1):176–86.PubMedCentralCrossRefPubMed

24.

Cedrés S, Nuñez I, Longo M, Martinez P, Checa E, Torrejón D, et al. Serum tumor markers CEA, CYFRA21-1, and CA-125 are associated with worse prognosis in advanced non-small-cell lung cancer (NSCLC). Clin Lung Cancer. 2011;12(3):172–9.CrossRefPubMed

25.

Szturmowicz M, Rudziński P, Kacprzak A, Langfort R, Bestry I, Broniarek-Samson B, et al. Prognostic value of serum C-reactive protein (CRP) and cytokeratin 19 fragments (Cyfra 21–1) but not carcinoembryonic antigen (CEA) in surgically treated patients with non-small cell lung cancer. Pneumonol Alergol Pol. 2014;82(5):422–9.PubMed

26.

Tomita M, Shimizu T, Ayabe T, Onitsuka T. Prognostic significance of the combined use of preoperative platelet count and serum carcinoembryonic antigen level in non-small-cell lung cancer. Gen Thorac Cardiovasc Surg. 2010;58(11):573–6.CrossRefPubMed

27.

Zhong W, Zhou C, Chen L, Wang Z, Lin H, Wu K, et al. The coefficient of variation of red blood cell distribution width combined with cancer antigen 125 predicts postoperative overall survival in endometrial cancer. Int J Gen Med. 2021;14:5903–10.PubMedCentralCrossRefPubMed

28.

Li Y, Xing C, Wei M, Wu H, Hu X, Li S, et al. Combining red blood cell distribution width (RDW-CV) and CEA predict poor prognosis for survival outcomes in colorectal cancer. J Cancer. 2019;10(5):1162–70.PubMedCentralCrossRefPubMed

29.

Xu R, You JH, Li F, Yan B. Postoperative fasting blood glucose predicts prognosis in stage I-III colorectal cancer patients undergoing resection. Gastroenterol Res Pract. 2020;2020:2482409.PubMedCentralCrossRefPubMed

30.

Zhang Y, Liu Y, Qiu X, Yan B. Concurrent comparison of the prognostic values of tumor budding, tumor stroma ratio, tumor infiltrating pattern and lymphocyte-to-monocyte ratio in colorectal cancer patients. Technol Cancer Res Treat. 2021;20:15330338211045826.PubMedCentralCrossRefPubMed

31.

Gao Y, Zhang H, Li Y, Wang D, Ma Y, Chen Q. Preoperative increased systemic immune-inflammation index predicts poor prognosis in patients with operable non-small cell lung cancer. Clin Chim Acta. 2018;484:272–7.CrossRefPubMed

32.

Xu S, Cao S, Geng J, Wang C, Meng Q, Yu Y. High prognostic nutritional index (PNI) as a positive prognostic indicator for non-small cell lung cancer patients with bone metastasis. Clin Respir J. 2021;15(2):225–31.CrossRefPubMed

33.

Ozyurek BA, Ozdemirel TS, Ozden SB, Erdoğan Y, Ozmen O, Kaplan B, et al. Does advanced lung inflammation index (ALI) have prognostic significance in metastatic non-small cell lung cancer? Clin Respir J. 2018;12(6):2013–9.CrossRefPubMed

34.

Liu C, Zhang H, Qi Q, Zhang B, Yue D, Wang C. The preoperative platelet distribution width: a predictive factor of the prognosis in patients with non-small cell lung cancer. Thorac Cancer. 2020;11(4):918–27.PubMedCentralCrossRefPubMed

35.

Matsui H, Taniguchi Y, Maru N, Utsumi T, Saito T, Hino H, et al. Prognostic effect of preoperative red cell distribution width on the survival of patients who have undergone surgery for non-small cell lung cancer. Mol Clin Oncol. 2021;14(5):108.PubMedCentralCrossRefPubMed

36.

Hanagiri T, Sugaya M, Takenaka M, Oka S, Baba T, Shigematsu Y, et al. Preoperative CYFRA 21–1 and CEA as prognostic factors in patients with stage I non-small cell lung cancer. Lung Cancer. 2011;74(1):112–7.CrossRefPubMed

37.

Nasralla A, Lee J, Dang J, Turner S. Elevated preoperative CEA is associated with subclinical nodal involvement and worse survival in stage I non-small cell lung cancer: a systematic review and meta-analysis. J Cardiothorac Surg. 2020;15(1):318.PubMedCentralCrossRefPubMed

38.

Colotta F, Allavena P, Sica A, Garlanda C, Mantovani A. Cancer-related inflammation, the seventh hallmark of cancer: links to genetic instability. Carcinogenesis. 2009;30(7):1073–81.CrossRefPubMed

39.

Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008;454(7203):436–44.CrossRefPubMed

40.

Butera G, Pacchiana R, Donadelli M. Autocrine mechanisms of cancer chemoresistance. Semin Cell Dev Biol. 2018;78:3–12.CrossRefPubMed

41.

Yan X, Han L, Zhao R, Fatima S, Zhao L, Gao F. Prognosis value of IL-6, IL-8, and IL-1β in serum of patients with lung cancer: a fresh look at interleukins as a biomarker. Heliyon. 2022;8(8):e09953.PubMedCentralCrossRefPubMed

42.

Silva EM, Mariano VS, Pastrez PRA, Pinto MC, Castro AG, Syrjanen KJ, et al. High systemic IL-6 is associated with worse prognosis in patients with non-small cell lung cancer. PLoS ONE. 2017;12(7):e0181125.PubMedCentralCrossRefPubMed

43.

Zheng X, Lu G, Yao Y, Gu W. An autocrine IL-6/IGF-1R loop mediates EMT and promotes tumor growth in non-small cell lung cancer. Int J Biol Sci. 2019;15(9):1882–91.PubMedCentralCrossRefPubMed

44.

Shang GS, Liu L, Qin YW. IL-6 and TNF-α promote metastasis of lung cancer by inducing epithelial-mesenchymal transition. Oncol Lett. 2017;13(6):4657–60.PubMedCentralCrossRefPubMed

45.

Duan S, Tsai Y, Keng P, Chen Y, Lee SO, Chen Y. IL-6 signaling contributes to cisplatin resistance in non-small cell lung cancer via the up-regulation of anti-apoptotic and DNA repair associated molecules. Oncotarget. 2015;6(29):27651–60.PubMedCentralCrossRefPubMed

46.

Kim SM, Kwon OJ, Hong YK, Kim JH, Solca F, Ha SJ, et al. Activation of IL-6R/JAK1/STAT3 signaling induces de novo resistance to irreversible EGFR inhibitors in non-small cell lung cancer with T790M resistance mutation. Mol Cancer Ther. 2012;11(10):2254–64.CrossRefPubMed

47.

Chang CH, Hsiao CF, Yeh YM, Chang GC, Tsai YH, Chen YM, et al. Circulating interleukin-6 level is a prognostic marker for survival in advanced nonsmall cell lung cancer patients treated with chemotherapy. Int J Cancer. 2013;132(9):1977–85.CrossRefPubMed

48.

Miyamoto K, Inai K, Takeuchi D, Shinohara T, Nakanishi T. Relationships among red cell distribution width, anemia, and interleukin-6 in adult congenital heart disease. Circ J. 2015;79(5):1100–6.CrossRefPubMed

49.

Fornal M, Wizner B, Cwynar M, Królczyk J, Kwater A, Korbut RA, et al. Association of red blood cell distribution width, inflammation markers and morphological as well as rheological erythrocyte parameters with target organ damage in hypertension. Clin Hemorheol Microcirc. 2014;56(4):325–35.CrossRefPubMed

50.

Zhang Z, Xiao Y, Zhao J, Chen M, Xu Y, Zhong W, et al. Relationship between circulating tumour cell count and prognosis following chemotherapy in patients with advanced non-small-cell lung cancer. Respirology. 2016;21(3):519–25.CrossRefPubMed

51.

Bayarri-Lara C, Ortega FG, CuetoLadrón de Guevara A, Puche JL, Ruiz Zafra J, de Miguel-Pérez D, et al. Circulating tumor cells identify early recurrence in patients with non-small cell lung cancer undergoing radical resection. PLoS One. 2016;11(2):e0148659.PubMedCentralCrossRefPubMed

52.

Bao H, Bai T, Takata K, Yokobori T, Ohnaga T, Hisada T, et al. High expression of carcinoembryonic antigen and telomerase reverse transcriptase in circulating tumor cells is associated with poor clinical response to the immune checkpoint inhibitor nivolumab. Oncol Lett. 2018;15(3):3061–7.PubMed

53.

Yamashita J, Matsuo A, Kurusu Y, Saishoji T, Hayashi N, Ogawa M. Preoperative evidence of circulating tumor cells by means of reverse transcriptase-polymerase chain reaction for carcinoembryonic antigen messenger RNA is an independent predictor of survival in non-small cell lung cancer: a prospective study. J Thorac Cardiovasc Surg. 2002;124(2):299–305.CrossRefPubMed

54.

Pantazaka E, Vardas V, Roumeliotou A, Kakavogiannis S, Kallergi G. Clinical relevance of mesenchymal- and stem-associated phenotypes in circulating tumor cells isolated from lung cancer patients. Cancers (Basel). 2021;13(9):2158.CrossRefPubMed

55.

Obermayr E, Koppensteiner N, Heinzl N, Schuster E, Holzer B, Fabikan H, et al. Cancer stem cell-like circulating tumor cells are prognostic in non-small cell lung cancer. J Pers Med. 2021;11(11):1225.PubMedCentralCrossRefPubMed

56.

Eramo A, Haas TL, De Maria R. Lung cancer stem cells: tools and targets to fight lung cancer. Oncogene. 2010;29(33):4625–35.CrossRefPubMed

57.

Zheng Y, Wang L, Yin L, Yao Z, Tong R, Xue J, et al. Lung cancer stem cell markers as therapeutic targets: an update on signaling pathways and therapies. Front Oncol. 2022;12:873994.PubMedCentralCrossRefPubMed

58.

Agarwal M, Brahmanday G, Chmielewski GW, Welsh RJ, Ravikrishnan KP. Age, tumor size, type of surgery, and gender predict survival in early stage (stage I and II) non-small cell lung cancer after surgical resection. Lung Cancer. 2010;68(3):398–402.CrossRefPubMed

59.

Chan EY, Amirkhosravi F, Nguyen DT, Chihara RK, Graviss EA, Kim MP. Lobectomy provides the best survival for stage I lung cancer patients despite advanced age. Ann Thorac Surg. 2022;114(5):1824–32.CrossRefPubMed

60.

Christensen NL, Løkke A, Dalton SO, Christensen J, Rasmussen TR. Smoking, alcohol, and nutritional status in relation to one-year mortality in Danish stage I lung cancer patients. Lung Cancer. 2018;124:40–4.CrossRefPubMed

61.

Zeng X, Zeng D, Cheng J, Xu C, Sun C, Long H, Zhu B. Influence of hypertension on the survival of non-small cell lung cancer patients with type 2 diabetes mellitus. Med Sci Monit. 2020;26: e921676.PubMedCentralCrossRefPubMed

62.

Palma DA, Tyldesley S, Sheehan F, Mohamed IG, Smith S, Wai E, Murray N, Senan S. Stage I non-small cell lung cancer (NSCLC) in patients aged 75 years and older: does age determine survival after radical treatment? J Thorac Oncol. 2010;5(6):818–24.CrossRefPubMed

63.

Sigel K, Bonomi M, Packer S, Wisnivesky J. Effect of age on survival of clinical stage I non-small-cell lung cancer. Ann Surg Oncol. 2009;16(7):1912–7.CrossRefPubMed

64.

Fujita T, Koyanagi A, Kishimoto K. Older age is not a negative factor for video-assisted thoracoscopic lobectomy for pathological stage I non-small cell lung cancer: a single-center, retrospective, propensity score-matching study. Surg Today. 2023. https://doi.org/10.1007/s00595-022-02628-y. Epub ahead of print.

65.

Ramos R, Macía I, Navarro-Martin A, Déniz C, Rivas F, Ureña A, et al. Prognostic value of the preoperative lymphocyte-to-monocyte ratio for survival after lung cancer surgery. BMC Pulm Med. 2021;21(1):75.PubMedCentralCrossRefPubMed

66.

Shao J, Li J, Zhang XL, Wang G. Prognostic significance of the preoperative controlled nutritional status score in lung cancer patients undergoing surgical resection. Nutr Cancer. 2021;73(11–12):2211–8.CrossRefPubMed

67.

Tomita M, Ayabe T, Nakamura K. The advanced lung cancer inflammation index is an independent prognostic factor after surgical resection in patients with non-small-cell lung cancer. Interact Cardiovasc Thorac Surg. 2018;26(2):288–92.CrossRefPubMed

68.

Liu W, Zhang T, Li L, Zou J, Xu C. Assessing the prognostic value of the neutrophil-to-lymphocyte ratio in stage I non-small-cell lung cancer with complete resection. Can Respir J. 2022;2022:6837872.PubMedCentralPubMed

69.

Shi Y, Li J, Zhang S, Wang M, Yang S, Li N, et al. Molecular epidemiology of EGFR mutations in Asian patients with advanced non-small-cell lung cancer of adenocarcinoma histology-mainland china subset analysis of the PIONEER study. PLoS ONE. 2015;10(11):e0143515.PubMedCentralCrossRefPubMed

70.

Pi C, Xu CR, Zhang MF, Peng XX, Wei XW, Gao X, et al. EGFR mutations in early-stage and advanced-stage lung adenocarcinoma: Analysis based on large-scale data from China. Thorac Cancer. 2018;9(7):814–9.PubMedCentralCrossRefPubMed

71.

Tang Y, Wang WY, Zheng K, Jiang L, Zou Y, Su XY, et al. EGFR mutations in non-small cell lung cancer: an audit from West China Hospital. Expert Rev Mol Diagn. 2016;16(8):915–9.CrossRefPubMed

72.

Cheng Y, Wang Y, Zhao J, Liu Y, Gao H, Ma K, et al. Real-world EGFR testing in patients with stage IIIB/IV non-small-cell lung cancer in North China: a multicenter, non-interventional study. Thorac Cancer. 2018;9(11):1461–9.PubMedCentralCrossRefPubMed

73.

Sheng J, Fang W, Liu X, Xing S, Zhan J, Ma Y, et al. Impact of gefitinib in early stage treatment on circulating cytokines and lymphocytes for patients with advanced non-small cell lung cancer. Onco Targets Ther. 2017;10:1101–10.PubMedCentralCrossRefPubMed

74.

Yang B, Qin A, Zhang K, Ren H, Liu S, Liu X, et al. Circulating tumor cells predict prognosis following tyrosine kinase inhibitor treatment in EGFR-mutant non-small cell lung cancer patients. Oncol Res. 2017;25(9):1601–6.PubMedCentralCrossRefPubMed

75.

Fiteni F, Westeel V, Bonnetain F. Surrogate endpoints for overall survival in lung cancer trials: a review. Expert Rev Anticancer Ther. 2017;17(5):447–54.CrossRefPubMed

76.

Yi H, Cho HJ, Cho SM, Jo K, Park JA, Kim NH, et al. Blockade of interleukin-6 receptor suppresses the proliferation of H460 lung cancer stem cells. Int J Oncol. 2012;41(1):310–6.PubMed

77.

Pignon JP, Tribodet H, Scagliotti GV, Douillard JY, Shepherd FA, Stephens RJD, et al. Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group. J Clin Oncol. 2008;26(21):3552–9.CrossRefPubMed

78.

Bayliss TJ, Smith JT, Schuster M, Dragnev KH, Rigas JR. A humanized anti-IL-6 antibody (ALD518) in non-small cell lung cancer. Expert Opin Biol Ther. 2011;11(12):1663–8.CrossRefPubMed

79.

Song L, Smith MA, Doshi P, Sasser K, Fulp W, Altiok S, et al. Antitumor efficacy of the anti-interleukin-6 (IL-6) antibody siltuximab in mouse xenograft models of lung cancer. J Thorac Oncol. 2014;9(7):974–82.PubMedCentralCrossRefPubMed

80.

Sawabata N, Kawaguchi T, Watanabe T, Yohikawa D, Ouji-Sageshima N, Ito T. Pure solid pattern of non-small cell lung cancer and clustered circulating tumor cells. Cancers (Basel). 2022;14(18):4514.CrossRefPubMed

Titel: A combined preoperative red cell distribution width and carcinoembryonic antigen score contribute to prognosis prediction in stage I lung adenocarcinoma
verfasst von: Hengliang Xu
Guangqiang Zhao
Jixing Lin
Qianwen Ye
Jia Xiang
Bing Yan
Publikationsdatum: 01.12.2023
Verlag: BioMed Central
Erschienen in: World Journal of Surgical Oncology / Ausgabe 1/2023
Elektronische ISSN: 1477-7819
DOI: https://doi.org/10.1186/s12957-023-02945-7

Neu im Fachgebiet Chirurgie

Vorsicht, erhöhte Blutungsgefahr nach PCI!

10.05.2024 Koronare Herzerkrankung Nachrichten

Nach PCI besteht ein erhöhtes Blutungsrisiko, wenn die Behandelten eine verminderte linksventrikuläre Ejektionsfraktion aufweisen. Das Risiko ist umso höher, je stärker die Pumpfunktion eingeschränkt ist.

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Deutlich weniger Infektionen: Wundprotektoren schützen!

08.05.2024 Postoperative Wundinfektion Nachrichten

Der Einsatz von Wundprotektoren bei offenen Eingriffen am unteren Gastrointestinaltrakt schützt vor Infektionen im Op.-Gebiet – und dient darüber hinaus der besseren Sicht. Das bestätigt mit großer Robustheit eine randomisierte Studie im Fachblatt JAMA Surgery.

Chirurginnen und Chirurgen sind stark suizidgefährdet

07.05.2024 Suizid Nachrichten

Der belastende Arbeitsalltag wirkt sich negativ auf die psychische Gesundheit der Angehörigen ärztlicher Berufsgruppen aus. Chirurginnen und Chirurgen bilden da keine Ausnahme, im Gegenteil.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Springer Medizin

Abstract

Aims

Materials and methods

Results

Conclusions

Publisher’s Note

Introduction

Materials and methods

Patients

Defining RCS and other inflammatory prognostic indicators

Follow-up and definition of DFS and OS

Statistical analysis

Results

Demographic characteristics of the cohort and the efficacy of RCS in prognosis

The differences in clinicopathological features among RCS subgroups

Correlation of RCS with other systematic inflammatory indicators

Survival differences among RCS subgroups

Univariate and multivariate analysis of risk factors for survival

Discussion

Conclusion

Acknowledgements

Declarations

Ethics approval and consent to participate

Consent for publication

Competing interests

Publisher’s Note

Weitere Artikel der Ausgabe 1/2023

Issues in the surgical management of skin squamous cell cancers in albinos—experience of two surgical oncology units in Burkina Faso

Evaluation of factors predicting postoperative recurrence and metastasis of parathyroid cancer: a single-center study

Triplet‐drug chemotherapy combined with anti‐EGFR antibody as an effective therapy for patients with initially unresectable metastatic colorectal cancer: a meta-analysis

Characteristics of systematic lymph node dissection and influencing factors of sentinel lymph node biopsy using carbon nanoparticles in endometrial carcinoma: a single-center study

Correction: Uniportal video-assisted anatomical segmentectomy: an analysis of the learning curve

Mixed small cell neuroendocrine carcinoma and squamous cell carcinoma covered by tubulovillous adenoma in the rectum: a case report and detailed molecular analyses

Update Chirurgie