The prognostic significance of the systemic immune-inflammatory index in surgically treated non-small cell lung cancers

eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2020-06-27 5 3 103 107 10.26663/cts.2020.00022 119 article The prognostic significance of the systemic immune-inflammatory index in surgically treated non-small cell lung cancers Muhammet Sayan 1 Irmak Akarsu 1 İsmail Tombul 1 Aykut Kankoç 1 Dilvin Özkan 1 Elgun Valiyev 1 Ali Celik 1 İsmail Cüneyt Kurul 1 Olgun Kadir Arıbaş 1 Abdullah İrfan Taştepe 1 Department of Thoracic Surgery, Gazi University School of Medicine, Ankara, TurkeyBackground: Lung cancer is a leading cause of cancer-related deaths worldwide, and the majority of lung cancer deaths are due to non-small cell cancers. The most important indicator of prognosis in lung cancer is the tumor stage. In recent years, studies investigating the correlation between cancer development, prognosis, and inflammation have increased. In our study, the prognostic efficacy of the systemic immune-inflammation index (SSI) was investigated in patients with surgically treated nonsmall cell lung cancer in pathologic stage III-A, according to the eighth edition TNM stage classification. Materials and Methods: Following the approval of the local ethics committee, the data of patients with stage III-A lung cancer who were operated on in our clinic between January 2010 and December 2019 were retrospectively analyzed. In accordance with the definitions in the literature, systemic immune-inflammation index groups were calculated using the following formula: (neutrophil count) x (platelet count) / (lymphocyte count) in the preoperative complete blood count tests of patients; the cut-off value was determined by ROC analysis. According to this value, high and low SSI groups were created. The survival difference between the groups was determined by Kaplan–Meier, log-rank, and Cox regression analysis. Results: A total of 181 patients were included in the study -27 women and 154 men. The median age was 62 (age range: 25 - 82), and the median tumor diameter was 4.5 cm (0.1 - 10 cm). The cut-off value for the SII was calculated as 1,046.105 by ROC analysis. There were 27 patients in the high SSI group and 154 patients in low SSI group. Survival was significantly worse in the high SSI group (P = 0.02, HR: 1.9, 95% CI). In addition, survival was significantly worse in the pneumonectomy group (P = 0.01). Conclusions: Using the SSI is a simple and inexpensive way to predict prognosis in patients with stage III-A lung cancer who are treated surgically. https://cts.tgcd.org.tr/pdf.php?id=119 lung cancerprognosissystemic immune-inflammatory index eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2020-06-27 5 3 108 117 10.26663/cts.2020.00023 120 article Changes in neutrophil to lymphocyte ratio after non-small cell lung cancer resection: a retrospective cohort study Armagan Hazar 1 Serda Kanbur Metin 2 Department of Chest Diseases, Health of Science University Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, İstanbul, TurkeyDepartment of Thoracic Surgery, Health of Science University Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, İstanbul, TurkeyBackground: Increasing neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) define and grade systemic inflammation in lung cancer patients. We hypothesized a decrease in NLR and PLR after tumor resection, and their potential prognostic value in follow-up. Materials and Methods: Adult patients diagnosed previously (and/or histopathologically after lung surgery) with NSCLC were enrolled from the1st January 2016 to 1st January 2018. Patients were grouped according to tumor size (≥ 5 cm and < 5 cm) and sub-grouped by gender and type of surgery (lobectomy and pneumonectomy). Patient information was recorded from the hospital database and included age, gender, hemogram and blood biochemistry values, results, and before and after lung resection. Total leukocyte count, neutrophil count, NLR, PLR, PLT/MPV, and C-reactive protein (CRP) were recorded and calculated. Mortality was recorded during the follow-up period. Results: Among the 314 included patients (56, 18% female, mean age 60 years, SD=11) pneumonectomy and lobectomy numbers were 56 (18%) and 258 (82%), respectively, and 92 (29%) patients had larger tumors and 222 (71%) had smaller tumors NLR, PLR and CRP median values immediately before and after tumor resection were 17.08 vs. 10.03, P < 0.001, 315.61 vs. 215.10, P < 0.001, and 9.0 vs. 9.5, P = 0.10, respectively. Median follow-up was 300 days (IQR 198-381), and 36 (11.5%) patients died. Cox regression showed that a post-operative NLR ≥ 12.0 was a significant prognostic indicator (HR: 2.09, CI 95% [1.08-4.06], and P = 0.029). Conclusions: NLR >12 after lung resection may be an important prognostic value for six-month mortality. NLR and PLR may be useful biomarkers in NSCLC immediately post-surgery and for long-term follow-up. https://cts.tgcd.org.tr/pdf.php?id=120 lung cancerneutrophillymphocytebiomarkersthoracic surgery eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2020-06-27 5 3 118 124 10.26663/cts.2020.00024 121 article Primary pulmonary carcinosarcomas: postoperative results and survival analysis Mustafa Vedat Dogru 1 Celal Bugra Sezen 1 Cemal Aker 1 Volkan Erdogu 1 Inanc Yazıcı 1 Aysun Olcmen 1 Muzaffer Metin 1 Department of Thoracic Surgery, Health of Science University, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, TurkeyBackground: In this study, we assessed the long-term results of 11 patients that we operated due to primary pulmonary carcinosarcoma in the light of literature. Materials and Methods: We analyzed 11 patients’ data, who underwent lung resection, retrospectively between 2009-2018. The comorbidity score was calculated according to the modified Charlson Comorbidity Index (CCI). Results: Of the 11 patients in the study, 10 (90.9%) were male, one was female (%9.1), and the median age of the subjects was 59.18 ± 8.86. Nine of the patients (81.8%) underwent lobectomy, two of them (18.1%) underwent pneumonectomy. As a cellular type, 6 of them have squamous cell carcinoma, 5 of them have adenocarcinoma. Furthermore, as a sarcomatous component, we detected 6 of the patients have spindle cell sarcoma, 3 of them have chondrosarcoma, one of them has osteosarcoma. and one patient has angiosarcoma. Nine complications occur postoperatively in 5 patients (45.9%). The fiveyear survival rate was 36.4%. Patients who received adjuvant chemotherapy, the five-year survival rate was 50%, meanwhile, patients who did not receive adjuvant chemotherapy five-year survival rate was not detected (P = 0.006). If the patients have CCI score is two and below their five-year survival rate was 44.4%, meanwhile if the patients have CCI score is two and above their five-year survival rate was not detected (P = 0.018). Recurrence or metastasis was diagnosed in 7 patients (63.6%) postoperatively. The 5-year disease-free survival rate is 12.5%. Conclusions: Surgical resection is still the most effective treatment modality for these patients. Adjuvant therapy and comorbidity are detected most important factors that affect the survival rate. https://cts.tgcd.org.tr/pdf.php?id=121 carcinosarcomasurvivalsurgerylung eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2020-06-27 5 3 125 130 10.26663/cts.2020.00025 122 article The relationship of platelet lymphocyte ratio with prognosis in patients with chronic obstructive pulmonary disease Mehmet Reşit Öncü 1 Ufuk Çobanoğlu 2 Department of Emergency Medicine, Van Yüzüncü Yıl University, Faculty of Medicine, Van, TurkeyDepartment of Thoracic Surgery, Van Yüzüncü Yıl University, Faculty of Medicine, Van, TurkeyBackground: The aim of this study is to analyze prognostic biomarkers, and determine the biomarkers which are more sensitive in the patients that were presented with acute chronic obstructive pulmonary disease (COPD) exacerbation to the emergency department. Materials and Methods: The data of 243 patients presented with acute COPD exacerbation and 122 COPD patients with stable status as control group were analyzed retrospectively. The patients, whose arterial blood gas (ABG) studied, with Acute COPD exacerbation were identified as Group I. The patients whose venous blood gas (VBG) studied were identified as Group II and stable COPD patients whose ABG studied were identified as Control Group. The prognostic biomarker values were compared in the patients of Group I, Group II and Control Group. Results: The mean age of the patients was 68.61 ± 11.02 and the mean age of the control group was 68.25 ± 11.07. It was found that platelet lymphocyte ratio (PLR) values were very high in both Group I and Group II compared to the control Group (P < 0.001). There was a significant difference related with mean erythrocyte distribution width (RDW) in Group I, mean erythrocyte volume (MCV)’ in group II, MPV and platelet count (PLT) in both Group I and Group II (P < 0.001). Conclusions: Especially in acute COPD exacerbation, PLR may be a useful inflammatory biomarker to reflect the severity and activity of inflammation in COPD patients. https://cts.tgcd.org.tr/pdf.php?id=122 chronic obstructive pulmonary diseasebiomarkerplatelet-lymphocyte ratioemergency department eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2020-06-27 5 3 131 136 10.26663/cts.2020.00026 123 article Rare and unusual tracheobronchial foreign bodies Huseyin Yildiran 1 Guven Sadi Sunam 1 Selcuk University Medical Faculty, Thoracic Surgery, Konya, TurkeyBackground: Foreign body aspirations are rare in adults but are common in children between the ages of 0-3. Clinically, cough is the most common complaint. Delays in diagnosis can cause complications in the lower respiratory tract and lung parenchyma. This study aimed to offer a reminder that rare and unusual foreign bodies may be the cause of tracheobronchial aspiration and to present the surgical approach. Materials and Methods: Patients who were admitted to our outpatient clinic or who were referred by other clinics for foreign body aspiration between January 2012 and January 2017 were retrospectively analyzed. Foreign objects such as coins, food pieces, toy pieces, and needles, which were routinely encountered, were excluded from the study. Gender, age, complaints, radiological findings, and surgical interventions were recorded. Results: There were five cases (four males, one female) under the age of 18 and three male cases above the age of 18. The average age was 21.18 ± 28.93. There was one case with laryngectomy. In six cases, the foreign body was removed by rigid bronchoscopy. Lung resection was performed in three cases (one lobectomy and one wedge resection). The foreign bodies were a pen tip, a piece of stone, a rivet from jeans, the LED of a remote control, a latch spring, a piece of a spoon, a wood piece, and a piece of a dental filling. Conclusions: Foreign body aspirations are among the most significant causes of morbidity and mortality, especially in the child age group. Diagnosis is possible through anamnesis, physical examination, and evaluation of radiological findings together. In the event of clinical suspicion, foreign body aspirations should be kept in mind regardless of age group. https://cts.tgcd.org.tr/pdf.php?id=123 airway managementbronchoscopic surgical procedurerespiratory aspiration eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2020-06-27 5 3 137 141 10.26663/cts.2020.00027 124 article Atypical uniportal thoracoscopic resection of a giant thymolipoma Hakkı Ulutaş 1 Muhammet Reha Çelik 1 Ayşenur Akatlı 2 Mehmet Ağar 1 İlham Gülçek 1 Emine Şamdancı 2 Erdal İn 3 Department of Thoracic Surgery, Faculty of Medicine, University of Inonu, Malatya, TurkeyDepartment of Pathology, Faculty of Medicine, University of Inonu, Malatya, TurkeyDepartment of Pulmonology, Faculty of Medicine, University of Fırat, Elazıg, TurkeyThymolipoma is a rare, slow-growing, benign anterior mediastinal tumor consisting of mature adipose tissue and thymic tissue. Herein we describe the case of a completely excised giant thymolipoma with uniportal video-assisted thoracoscopic surgery, which was detected incidentally on chest X-ray, with the review of the literature. A 30-year-old male patient was hospitalized to the department of general surgery with the diagnosis of appendicitis. Preoperative chest x-ray revealed mediastinal enlargement extending to the diaphragm at right paracardiac area where cardiac contours were erased and cardiomegaly-like appearance was observed. In the contrast-enhanced computed tomography of the chest, a massive mass of soft tissue was detected in fat density. The mediastinal lesion was completely excised with uniportal VATS. Histopathologically, the tumor was reported to be thymolipoma. Thymolipoma it should be totally removed with VATS surgery for both diagnosis and treatment. https://cts.tgcd.org.tr/pdf.php?id=124 thymolipomauniportal VATSmediastinal massgiant eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2020-06-27 5 3 142 145 10.26663/cts.2020.00028 125 article A mass-forming extramedullary hematopoiesis case mimicking mediastinal neoplasia Ramazan Uçak 1 Özlem Ton Eryılmaz 1 Uğur Temel 2 Fevziye Kabukcuoğlu 1 Department of Pathology, University of Health Sciences, Şişli Hamidiye Etfal Health Application and Research Center, Istanbul, TurkeyDepartment of Thoracic Surgery, University of Health Sciences, Şişli Hamidiye Etfal Health Application and Research Center, Istanbul, TurkeyExtramedullary hematopoiesis (EMH) is a condition that usually coexists with hematological disorders and rarely causes mass formation. It can occur anywhere in the body, but very rarely becomes a tumorlike mass in the posterior mediastinum and paravertebral region. A 41-year-old female patient presented with respiratory distress. Radiologically, multiple large mass lesions were detected in the posterior mediastinum, localized bilaterally at paravertebral regions. Diagnostic studies with transthoracic biopsy specimen were showed that the mass lesion was consisting of myelocytes, lymphocytes, erythrocytes and megakaryocytes, so the case was reported as EMH. The case was presented to make a differential diagnosis, because it mimics solid neoplasms at unusual localizations, and may accompany hematological disorders. https://cts.tgcd.org.tr/pdf.php?id=125 extramedullary hematopoiesissolid massposterior mediastinum eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2020-06-27 5 3 146 148 10.26663/cts.2020.00029 126 article A rare presentation of a rare disease: endobronchial hamartoma with lobar bronchiectasis Ömer Yavuz 1 Murat Kapdağlı 2 Suat Erus 3 Pınar Bulutay 4 Serhan Tanju 3 Department of General Thoracic Surgery, Koç University Hospital, Istanbul, TurkeyDepartment of General Thoracic Surgery, VKF American Hospital, Istanbul, TurkeyDepartment of General Thoracic Surgery, Koç University School of Medicine, Istanbul, TurkeyDepartment of Pathology, Koç University Hospital, Istanbul, TurkeyBenign lung tumors are very rare, endobronchial hamartomas -one of which- are even more rare. Endobronchial masses tend to represent themselves via obstruction related symptoms and endobronchial hamartomas are not an exception. It is important to diagnose endobronchial masses before they bring untreatable damage to the lung. It is also important to differentiate endobronchial hamartomas from endobronchial malignancies, such as carcinomas, for they also tend to act mildly symptomatic for a long period of time. In our case, the patient was admitted to our clinic with the symptoms of cough and mild hemoptysis. A computed chest tomography showed total bronchiectasis of right upper lobe along with an endobronchial mass in the right upper lobe bronchus. Bronchoscopic biopsy of the mass revealed no diagnosis. We performed a right upper lobectomy and the pathological examination resulted as endobronchial hamartoma. There are numerous cases about endobronchial hamartomas in the literature which represented with countless symptoms and diseases as persistent cough, recurrent pneumonia, local bronchiectasis and so forth. Our case of endobronchial hamartoma representing with total bronchiectasis of a whole lobe of the lung is the first and only case in the English literature to our knowledge. https://cts.tgcd.org.tr/pdf.php?id=126 endobronchial hamartomaendobronchial massbronchiectasisvideothoracoscopic surgerylobectomy eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2020-06-27 5 3 149 152 10.26663/cts.2020.00030 127 article Cryosurgery of endobronchial tuberculosis facilitated by foley’s catheter usage for both intubation and distal airway safety Şevki Mustafa Demiröz 1 Gülşen Yılmaz 1 Göktürk Fındık 1 Department of Thoracic Surgery, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TurkeyA 35-year-old female with a reproductive cough, dyspnea, stridor, and intermittent hemoptysis was evaluated by fiberoptic bronchoscopy (FOB). An endobronchial lesion was observed 2 cm distal to the vocal cords, occluding two-thirds of the tracheal lumen. Rigid bronchoscopy and total excision of the lesion with cryosurgery were planned. Under general anesthesia, a 14-mm rigid bronchoscope (RB) was introduced. As a facilitative new technique, the patient was intubated with an 18F Foley catheter, which was introduced close to the RB. The cuff of the catheter was then inflated distally to the lesion. Subsequently, the catheter was connected to a mechanical ventilator to ensure the safety of the airway while preventing hypoxia. Total excision of the mass was performed via cryosurgery. Immediately after, the catheter balloon was deflated, and a fiberoptic bronchoscope was introduced through the RB to explore the distal bronchial system for aspirated tissue fragments and secretions. With this facilitative approach, the distal airway was kept clean of secretions and tissue fragments. The final pathology of the mass was granulomatous inflammation and necrosis, and the patient was referred to a tuberculosis clinic for medical treatment. https://cts.tgcd.org.tr/pdf.php?id=127 dyspneaendobronchial tuberculosisendobrochial treatmentcryosurgery