RESUMO
Patients with non-small cell carcinoma of the lung (NSCLC) have a poor prognosis (64 and 41% survival rates in Stages I and II). It is currently not possible to predict which patients with Stage I or II NSCLC will survive the disease. Sixty-seven patients with NSCLC, including 49 patients with Stage I NSCLC and 18 with Stage II disease (11 with squamous cell carcinomas, 35 with adenocarcinomas, and 21 with large cell carcinomas) were treated with lobectomy and followed for a minimum of 5 years. The tumors were studied with DNA flow cytometry and quantitative immunocytochemical studies for proliferation cell nuclear antigen, p53 protein, and MIB-1. The data were analyzed with backpropagation neural networks, univariate analysis of variance, the Kaplan-Meier survival method, and Cox proportional hazards model. The dependent variables were "free of disease" and "recurrence or dead from disease." Twenty neural network models were trained, using all cases but one, after 1883 to 2000 training cycles. At 5 years, 30 patients were free of disease and 37 were dead or had recurrence. Proliferating cell nuclear antigen was the only statistically significant prognostic factor by univariate analysis of variance and Cox proportional hazards analysis. The S phase was statistically significant by univariate analysis of variance (P <.05). All of the 20 models classified the test cases correctly. Study with backpropagation neural networks using multiple prognostic features from patients with NSCLC suggests that this technology might be useful for prediction of survival. This preliminary study must be validated with data from a larger group of patients with NSCLC before its clinical adequacy is established.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Redes Neurais de Computação , Adenocarcinoma/diagnóstico , Antígenos Nucleares , Biomarcadores Tumorais/análise , Carcinoma de Células Grandes/diagnóstico , Carcinoma Pulmonar de Células não Pequenas/química , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma de Células Escamosas/diagnóstico , Citometria de Fluxo , Humanos , Imuno-Histoquímica , Antígeno Ki-67 , Neoplasias Pulmonares/química , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/mortalidade , Proteínas Nucleares/análise , Ploidias , Prognóstico , Antígeno Nuclear de Célula em Proliferação/análise , Taxa de Sobrevida , Proteína Supressora de Tumor p53/análiseRESUMO
Pulmonary and cardiac complications are known to be the most frequent causes of morbidity and mortality after thoracic surgery. We attempted to correlate the relationship between the complications with preoperatively cardiac, pulmonary and cardiopulmonary risk indices in patients undergoing pulmonary resections. Complicatiosn in 15 consecutive patients with high cardiac (GoldmanÝs index); pulmonary (TorringtonÝs index) or cardiopulmonary (exercise capacity less than 3 METS) risk indices were compared with 31 consecutive patients without that risk factores. Nineteen complications developed in 15 patients in the high risk group and 4 complications occurred in 31 patients in the low risk group (p<0.0001). Death occurred in 8 patients in the high risk group, there were no deaths in the low risk group. Causes of death were: Pneumonia 4; Contralateral bronchial obstruction 1; Cardiac death 1; Pulmonary Embolism 1 and Sepsis 1 patient. Patients assigned to Goldman cardiac index = 3 or 4; Torrington pulmonary index = 3 and maximal exercise capacity tower than 3 METS correlated well with high morbidity and mortality. Using together the three indices, sensitivity was similar but specificity was better: all the patients who eventually died postoperatively had been preoperatively assigned to the high risk group. Our findings suggest that outcome and severity of complications after resective pulmonary surgery correlate with high risk cardiac, pulmonary and/or cardiopulmonary predictive indices.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Complicações Pós-Operatórias , Fatores de RiscoRESUMO
We report the case of a 36-year-old woman who suffered tracheal dilatation and rupture despite careful monitoring of intracuff pressure. Surgical manipulation, postoperative mediastinitis, and bacterial staphylococcal tracheitis may be involved in the development of this complication.