Objective To investigate the prognostic value of preoperative inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and fibrinogen-to-prealbumin ratio (FPR), for postoperative survival in patients with resectable esophageal squamous cell carcinoma (ESCC). Additionally, to construct and validate a prognostic model for ESCC based on these inflammatory markers combined with TNM staging. Methods We retrospectively analyzed the clinical data of patients with histologically confirmed ESCC who underwent surgical resection at the First Affiliated Hospital of the University of Science and Technology of China during 2017. Receiver operating characteristic (ROC) curves were used to determine the optimal cut-off values for preoperative NLR, PLR, SII, and FPR. Clinicopathological characteristics were compared between patient groups with different levels of these markers. Survival analysis was performed using the Kaplan-Meier method, and univariate and multivariate regression analyses were conducted using the Cox proportional hazards model to identify prognostic factors. Nomograms for predicting overall survival (OS) and disease-free survival (DFS) were constructed using R software. The model's discrimination was assessed with ROC curves, its calibration was evaluated with calibration curves, and its clinical utility was determined by decision curve analysis (DCA). Results A total of 224 patients who underwent surgery for ESCC were included, comprising 180 males and 44 females. The optimal preoperative cut-off values of NLR, PLR, SII, and FPR for predicting postoperative OS were 2.70, 140.34, 360.73, and 0.015, respectively. The 5-year OS and DFS rates in the high-NLR group were lower than in the low-NLR group (both P<0.001). Similarly, patients in the high-PLR group (P=0.005 and P=0.009, respectively), high-SII group (P=0.008 and P=0.018, respectively), and high-FPR group (both P<0.001) had lower 5-year OS and DFS rates compared to their low-level counterparts. Multivariate Cox regression analysis revealed that patient age, T stage, N stage, tumor differentiation, and NLR>2.70 et al were independent prognostic factors for both OS and DFS. Based on these factors, nomograms for OS and DFS were constructed. The area under the ROC curve (AUC) for 3- and 5-year OS were 0.966 and 0.907, respectively, and for 3- and 5-year DFS were 0.960 and 0.919, respectively. The calibration curves showed good agreement between predicted and actual outcomes. DCA demonstrated that the models provided a positive net benefit for all patients under intervention. Conclusion Preoperative levels of NLR, PLR, SII, and FPR are associated with the prognosis of patients with ESCC, with NLR being an independent prognostic predictor. The nomogram models, constructed based on patient age, tumor differentiation, T stage, N stage, and preoperative NLR level, can accurately predict the prognosis of patients with ESCC. These models may help guide preoperative clinical decision-making and tailor treatment and follow-up strategies.
Objective To analyze the risk factors for chronic cough following pulmonary surgery in patients with non-small cell lung cancer (NSCLC). Methods A retrospective analysis was conducted on 427 NSCLC patients who underwent pulmonary surgery in the Department of Thoracic Surgery, The First Affiliated Hospital of the University of Science and Technology of China, between January 2021 and June 2023. Patients were categorized into a chronic cough group (103 patients) and a non-chronic cough group (324 patients) based on the presence of cough at 8 weeks post-surgery. A comparative analysis was performed between the two groups, considering gender, age, smoking history, comorbidities, preoperative pulmonary function indicators, pleural adhesion, anesthesia duration, surgical site, operative techniques, lymph node dissection methods, tumor maximum diameter, and postoperative chest tube duration. Factors showing statistical significance in univariate analysis underwent multivariate logistic regression analysis. Results Among the 427 patients undergoing pulmonary surgery, there were 165 males and 262 females, with an average age of (59.93±12.11) years. The incidence of chronic cough was 24.12%. Univariate analysis revealed significant differences in smoking history, preoperative pulmonary function indicators, pleural adhesion, anesthesia duration ≥135.5 minutes, surgical site, operative techniques, lymph node dissection methods, tumor maximum diameter, and postoperative chest tube duration (P<0.05). Multivariate logistic regression analysis indicated that the surgical site (right upper lung), operative techniques (lobectomy), lymph node dissection, and anesthesia time ≥135.5 minutes were independent risk factors for chronic cough following pulmonary surgery. ConclusionPatients undergoing right upper lung surgery, lobectomy, lymph node dissection, and experiencing anesthesia duration ≥135.5 minutes are at a higher risk of developing chronic cough post-pulmonary surgery.
In recent years, the number of lung surgeries has increased year by year, and the number of patients with postoperative cough has also increased gradually. Chronic cough after lung surgery seriously affects patients' quality of life and surgical outcome, and has become one of the clinical problems that clinicians need to solve. However, there is currently no guideline or consensus for the treatment of chronic cough after lung surgery in China, and there is no standardized treatment method. Therefore, we searched databases such as PubMed, Web of Science, CNKI, and Wanfang databases ect. from 2000 to 2023 to collected relevant literatures and research data, and produced the first expert consensus on chronic cough after lung surgery in China by Delphi method. We gave 11 recommendations from five perspectives including timing of chronic cough treatment, risk factors (surgical method, lymph node dissection method, anesthesia method), prevention methods (preoperative, intraoperative, postoperative), and treatment methods (etiological treatment, cough suppressive drug treatment, traditional Chinese medicine treatment, and postoperative physical therapy). We hope that this consensus can improve the standardization and effectiveness of chronic cough treatment after lung surgery, provide reference for clinical doctors, and ultimately improve the quality of life of patients with chronic cough after lung surgery.