Artificial Intelligence, Synergetics, Complex System Analysis and Simulation of Alive Supersystems for Optimal Management of Local Advanced Lung Cancerg.
Dr. Oleg Kshivets1
1Bagrationovsk Hospital, Bagrationovsk, Russian Federation
Survival of patients with local advanced of lung cancer (LC) takes several months. Radical operations are extremely complex, remain prerogative of several top thoracic surgeons of the world. Search of optimal treatment plan for LC patients (LCP) with stage T3-4N0-2M0 was realized. We examined prognostic factors for 5-year survival (5YS) of LCP after complete combined lobectomies/pneumonectomies (LP).
METHODS: We analyzed data of 198 LCP (age=58.1±8.2 years) operated, monitored in 1985-2024 (m=173, f=25; bi/lobectomies=84, pneumonectomies=114, mediastinal lymph node dissections=198; combined LP=198; only surgery-S=117, adjuvant chemoimmunoradiotherapy-AT=81: CAV/gemzar+cisplatin +thymalin+radiotherapy 45-50Gy; T3=137, T4=61; N0=94, N1=44, N2=60, squamous=118, adenocarcinoma=65, large cell=15. Cox, SEPATH, Monte Carlo, bootstrap, neural networks were used to determine significant dependence.
RESULTS: Overall life span (LS) was 1671.7±1721.6 days, 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028). Cox displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors, LC cell dynamics, prothrombin index, AT, procedure (P=0.000-0.031). Neural networks, bootstrap revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC, erythrocytes/CC, healthy cells/CC.
CONCLUSIONS: 5YS of LCP after combined procedures significantly depended on: tumor characteristics, LC cell dynamics, blood cell circuit, cell ratio factors, biochemical factors, hemostasis system, anthropometric data, AT , procedure. Optimal strategies for local advanced LCP are: availability of very experienced thoracic surgeons; aggressive en block surgery; precise prediction; AT for LCP with unfavorable prognosis.