Systemic inflammatory changes and their clinical implications following thoracic cancer surgery

Fornasiero, Massimiliano; Geropoulos, Georgios; Giannis, Dimitrios; Enson, Joshua; Aquilina, Julian; Bhakhri, Kunal

doi:10.1007/s12055-021-01301-2

Cited by 2 publications

(1 citation statement)

References 58 publications

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“…On the other hand, the Danish Trial [9][10][11] showed that MIS was preferred over the open approach (84% and 16%, respectively). MIS results in less post-operative pain via a reduction in the immune-mediated inflammatory reaction [70][71][72], resulting in early discharge; quicker functional recovery, and hence rapid return to daily living activities [73][74][75]; and improved aesthetic results [76]. In our study, surgeons preferred an MIS approach, either by RATS or VATS, to thoracotomy (84 vs. 12%), as in the Danish trial, but with RATS being the most predominant (56%).…”

Section: Discussionmentioning

confidence: 58%

The Smokers Health Multiple ACtions (SMAC-1) Trial: Study Design and Results of the Baseline Round

Antonicelli,

Muriana,

Favaro

et al. 2024

Cancers

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Background: Lung cancer screening with low-dose helical computed tomography (LDCT) reduces mortality in high-risk subjects. Cigarette smoking is linked to up to 90% of lung cancer deaths. Even more so, it is a key risk factor for many other cancers and cardiovascular and pulmonary diseases. The Smokers health Multiple ACtions (SMAC-1) trial aimed to demonstrate the feasibility and effectiveness of an integrated program based on the early detection of smoking-related thoraco-cardiovascular diseases in high-risk subjects, combined with primary prevention. A new multi-component screening design was utilized to strengthen the framework on conventional lung cancer screening programs. We report here the study design and the results from our baseline round, focusing on oncological findings. Methods: High-risk subjects were defined as being >55 years of age and active smokers or formers who had quit within 15 years (>30 pack/y). A PLCOm2012 threshold >2% was chosen. Subject outreach was streamlined through media campaign and general practitioners’ engagement. Eligible subjects, upon written informed consent, underwent a psychology consultation, blood sample collection, self-evaluation questionnaire, spirometry, and LDCT scan. Blood samples were analyzed for pentraxin-3 protein levels, interleukins, microRNA, and circulating tumor cells. Cardiovascular risk assessment and coronary artery calcium (CAC) scoring were performed. Direct and indirect costs were analyzed focusing on the incremental cost-effectiveness ratio per quality-adjusted life years gained in different scenarios. Personalized screening time-intervals were determined using the “Maisonneuve risk re-calculation model”, and a threshold <0.6% was chosen for the biennial round. Results: In total, 3228 subjects were willing to be enrolled. Out of 1654 eligible subjects, 1112 participated. The mean age was 64 years (M/F 62/38%), with a mean PLCOm2012 of 5.6%. Former and active smokers represented 23% and 77% of the subjects, respectively. At least one nodule was identified in 348 subjects. LDCTs showed no clinically significant findings in 762 subjects (69%); thus, they were referred for annual/biennial LDCTs based on the Maisonneuve risk (mean value = 0.44%). Lung nodule active surveillance was indicated for 122 subjects (11%). Forty-four subjects with baseline suspicious nodules underwent a PET-FDG and twenty-seven a CT-guided lung biopsy. Finally, a total of 32 cancers were diagnosed, of which 30 were lung cancers (2.7%) and 2 were extrapulmonary cancers (malignant pleural mesothelioma and thymoma). Finally, 25 subjects underwent lung surgery (2.25%). Importantly, there were zero false positives and two false negatives with CT-guided biopsy, of which the patients were operated on with no stage shift. The final pathology included lung adenocarcinomas (69%), squamous cell carcinomas (10%), and others (21%). Pathological staging showed 14 stage I (47%) and 16 stage II-IV (53%) cancers. Conclusions: LDCTs continue to confirm their efficacy in safely detecting early-stage lung cancer in high-risk subjects, with a negligible risk of false-positive results. Re-calculating the risk of developing lung cancer after baseline LDCTs with the Maisonneuve model allows us to optimize time intervals to subsequent screening. The Smokers health Multiple ACtions (SMAC-1) trial offers solid support for policy assessments by policymakers. We trust that this will help in developing guidelines for the large-scale implementation of lung cancer screening, paving the way for better outcomes for lung cancer patients.

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Section: Discussionmentioning

confidence: 58%

The Smokers Health Multiple ACtions (SMAC-1) Trial: Study Design and Results of the Baseline Round

Antonicelli,

Muriana,

Favaro

et al. 2024

Cancers

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The effect of opioid-free anesthesia using lidocaine on the level of inflammatory markers in thoracic patients in the intra- and postoperative period: prospective randomized study

Zhikharev,

Bushuev,

Zimina

et al. 2024

Regional Anesthesia and Acute Pain Management

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BACKGROUND: A pressing issue still remains the reduction of opioid analgesic dosages as a part of anesthesiological support, due to the wide range of complications they cause. An alternative to opioids is opioid-free anesthesia, including the use of lidocaine, which can influence the activity of cytokines, which reflects the advisability of its use in order to prevent an increase in the content of inflammatory markers in the postoperative period. In the domestic and foreign scientific literature, the issue of the dependence of the level of inflammatory markers on the use of non-opioid anesthesia in comparison with opioid anesthesia is relatively little studied, especially in the field of thoracic surgery. AIM: Our aim was to conduct a comparative analysis of the content of cytokines as markers of inflammation during anesthesia using intravenous lidocaine infusion, intravenous fentanyl infusion and a combination of intravenous fentanyl and epidural anesthesia. MATERIALS AND METHODS: A single-center, prospective, randomized study was conducted among 90 patients with a verified diagnosis of lung cancer who underwent video-assisted thoracoscopic (Vlobectomy. Depending on the method of anesthesia, patients were divided into 3 groups of 30 people: in the 1st group, lidocaine was administered, in the 2nd group, fentanyl was administered, and in the 3rd group, fentanyl was administered in combination with epidural anesthesia. The main result of the study was the assessment of the concentration of cytokines in the blood serum (interleukins - IL-2, IL-6, IL-10, as well as tumor necrosis factor α — TNF-α) using an enzyme-linked immunosorbent assay. An additional outcome was a laboratory assessment of the concentrations of glucose and cortisol in the blood serum (the analysis of these indicators was performed to assess the adequacy of anesthetic management in the intraoperative period). Statistical analysis of the results was carried out using the Python v.3.0 programming language in Jupiter Notebook. RESULTS: Analysis of IL-6 content showed a significant difference in favor of group 1 already at the end of the operation (H=10.366691, p=0.0056); 1 day after the end of the operation, the difference in the indicator between the groups increased (H=65.603614 , p 0.001) with the lowest value in group 1. The level of TNF-α at the end of the operation did not reflect significant differences between the groups (H=0.578241, p=0.748922), however, after 24 hours, changes made it possible to note positive dynamics also in group 1 (H=12.928289 , p=0.001558). Similar results were recorded for IL-10 [(H=1.325812, p=0.515352) and (H=9.11072, p=0.010511)] and IL-2 [(H=5.185739, p=0.074805) and (H=23.420171, p=0.000008)], respectively. CONCLUSION: Our results showed that opioid-free anesthesia based on intravenous lidocaine infusion positively correlates with serum concentrations of IL-2, IL-6, IL-10, and TNF-α in patients undergoing thoracic surgery. Serum levels of these cytokines may be indicators of inflammatory responses and may have clinical implications for selecting appropriate anesthesia for patients with lung cancer. In addition, data regarding IL-2 are new and may be associated with tumor progression and the occurrence of distant metastases.

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Systemic inflammatory changes and their clinical implications following thoracic cancer surgery

Cited by 2 publications

References 58 publications

The Smokers Health Multiple ACtions (SMAC-1) Trial: Study Design and Results of the Baseline Round

The Smokers Health Multiple ACtions (SMAC-1) Trial: Study Design and Results of the Baseline Round

The effect of opioid-free anesthesia using lidocaine on the level of inflammatory markers in thoracic patients in the intra- and postoperative period: prospective randomized study

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