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Jitian Zhang
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P07 - Early Stage/Localized Disease - Imaging and Biomarkers (ID 116)
- Event: WCLC 2020
- Type: Posters
- Track: Early Stage/Localized Disease
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P07.08 - IDO Immune Suppression and Post Surgical Toxicity in Patients with Non-Small Cell Lung Cancer (ID 3835)
00:00 - 00:00 | Author(s): Jitian Zhang
- Abstract
Introduction
A powerful blood biomarker could assist surgeon in determining the factors affecting the surgery toxicity of the lung cancer patients. Here, we evaluate the activity of the indoleamine 2, 3-dioxygenase (IDO) 1 , which was indicated by the ration of kyn and trp, in the blood and analyzed the association of the IDO1 activity with the post-surgery toxicity in patients with lung cancer. Hence, we aimed to investigate the IDO1 activity in different steps of surgery operation and its relationship with post-surgery toxicity in patients with lung cancer.
Methods
This is part of prospective cross-sectional study of treatment toxicity, quality of life and biomarker study. Patients aged 18-year old and above requiring Q were eligible. The post toxicity was evaluated by the treating physicians and graded according to NIH/NCI CTCAE v4.0. The variables of our interest included age, gender, Body mass index (can be calculated), weight/weight loss, KPS, comorbidity score, smoking history, tumor type, stage, size, histology. The high-performance chromatography (Waters) was used for assay of the IDO1 activity. Briefly, the Mobile phase A (2.5% acetonitrile in distilled water and mobile phase acetonitrile were delivered with Solvent pumps at the flow rate of 0.4 ml per minute (0 to 2.5 minutes 100% A, 2.5 to 4 minutes 100% A to 90% A linear gradient). Kynurenine was detected on an UV/vis channel at 360nm and tryptophan was detected at 285nm excitation. Data are presented as mean (95% confidence interval), OR (odds ratio) unless otherwise specified. Statistical significances were tested using the linear regression model. P < 0.05 were considered to be significant.
Results
A total of 105 patients scheduled to thoracic surgery enrolled this study. The blood samples of the patients were collected in five time-points: pre-anesthesia, post-anesthesia, before blood vessel cut, sample removal, 3 days of post-surgery. We found that the hiccups was closely associated with the IDO1 activity in blood taken before the step of blood vessel cut (OR = 1.34, CI: 1.15-1.58, p = 7E-04). Interesting, we also found that the hoarseness symptoms was closely associated with IDO1 activity in blood taken 3 days post-surgery (OR = 15.49, CI:2.09-114.89, p = 0.01). Furthermore, the constipation symptoms were associated with the blood taken when the samples were removed (OR = 1.349, CI:1.033-1.761, p = 0.03).
Conclusion
This study showed a close relationship between the IDO1 activity with the post surgery toxicity in patients with non-small cell lung cancer. Further validation study is warranted to validate our findings with large sample size of patients and further consideration of other confounding factors. This finding might reveal a potential role of IDO1 immune biomarker in defining approaches of surgery management to improve quality of life.
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P11 - Health Services Research/Health Economics - Quality of Life (ID 123)
- Event: WCLC 2020
- Type: Posters
- Track: Health Services Research/Health Economics
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P11.02 - Patient Reported Outcome Measures (PROM) after Thoracic Surgery: A Pilot Study (ID 2250)
00:00 - 00:00 | Presenting Author(s): Jitian Zhang
- Abstract
Introduction
Quality of life (QOL) particularly the changes immediately after surgery is largely unknown for Chinese Patients. This study aimed to exam the QOL, i.e. Patient Reported Outcome Measures (PROM) before and after the procedure in patients treated with thoracic surgery.
Methods
This is a prospective pilot study of PROM. Self-addressed PROM questionnaires of QOL according to National Institute of Health Patient-Reported Outcomes Measurement Information System (PROMIS) were used to assess QOL for patients undergoing thoracic surgery. The PROM included fatigue, depression, anxiety, sleep disturbance, physical function (PF), ability to participate in social roles and activities (APS) and pain interference (PI). The questionnaires were administered at the following time points: baseline before the surgery, postoperative day 2, at discharge and 1 month follow-up.
Results
A total of 38 patients were enrolled for the trial between November 2019 to February 2020. Thirty-four patients underwent minimally invasive surgery and the remaining had open surgery. 16 (44%) and 8 (22%) patients had lobectomy and sublobectomy, respectively. Before surgery, 37 (97%) had some degree of QOL impairment. Postoperatively, there was a significant reduction in PF (p = 8.44 x 10-6) and APS (p = 0.0007), an increase in fatigue (p = 0.01) and worsening in PI (p = 0.0002). The difference of fatigue disappeared at discharge, while the differences of other measures remained at discharge and disappeared at 1 month follow-up. There was a significant difference between traditional open procedure and minimally invasive surgery in the above four measures (p = 0.001 for PF, 8.90 x 10-6 for fatigue, 0.0002 for APS and 0.002 for PI) while there was no difference between lobectomy and sublobectomy (p > 0.05).
Conclusion
This study demonstrated immediate worsening in the QOL in patients after thoracic surgery, but a speedy recovery in majority of them. The QOL in this limited study appear to be better than reported in literature at 1 month, maybe contributing to the high percentage of minimally invasive surgery. Validation studies with larger sample size will be reported at the meeting.
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P32 - Palliative and Supportive Care - Misc. Topics (ID 220)
- Event: WCLC 2020
- Type: Posters
- Track: Palliative and Supportive Care
- Presentations: 2
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P32.07 - Shortness of Breath in Patients After Thoracomy: A Pilot Study (ID 3861)
00:00 - 00:00 | Author(s): Jitian Zhang
- Abstract
Introduction
Post operation shortness of breath (SOB) can be serious, is often a limiting factor for patients elected for thoracic surgery. Most of the published studies have been focused on the need of oxygen dependence after surgery, with little known on the significance of SOB level on the overall score of quality of life of the patient. The purpose of this study is to 1) exam SOB at baseline, 2) changes after surgery and 3) the relationship between SOB and post-surgical quality of life in patients after thoracic surgery.
Methods
This is part of prospective cross-sectional study of treatment toxicity, quality of life and biomarker study. Patients aged 18-year old and above requiring thoracotomy were eligible. The primary endpoint is SOB which was assessed the treating physicians and graded according to NIH/NCI CTCAE v4.0 one day prior to, immediately after surgery, at the time of discharge and at 1 month follow-up. Quality of life was assessed by self-administrated questionnaires PROMIS tool per NIH recommendation. The variables of our interest included age, gender, Body mass index, Charleston’s comorbidity score, weight/weight loss, KPS, tumor type, T stage, N stage, histology, and type of lung resection. Data are presented as mean or n/N (%) unless otherwise specified. Statistical significances were tested using Wilcoxon test. P less than 0.05 were considered to be significant.
Results
Between September 2019 and January 2020, a total of 39 patients scheduled for VATS enrolled this study. Except for 4 patients of traditional open thoracotomy, 35 (89.7%) underwent minimally invasive thoracotomy. The median age was 56 years (interquartile range, 46-65; range, 31-76 years) and 15 (38.5%) were men. Of the 39 patients, 31（79.5%）patients were never smoker, and none of them had history of COPD. 1/39 (2.6%), 1/39 (2.6%) and 1/39 (2.6%) patients had grade 1, 2, and 3 SOB at baseline, respectively.2 days after operation,4/39 (10.3%), 3/39 (7.7%) and 2/39 (5.1%) patients had grade 1, 2, and 3 SOB.7/39 (17.9%), 1/39 (2.6%) and 2/39 (5.1%) patients had grade 1, 2, and 3 SOB when they discharge from hosipital.At one month after surgery，8/39 (20.5%), 1/39 (2.6%) and 1/39 (2.6%) patients had grade 1, 2, and 3 SOB.Three out of 39 (7.7%) patients had SOB prior to surgery, versus 9 (23.1%) patients at 2 days after surgery,10(25.6%) patients at discharge from hospital and10 (25.6%) at 1 month follow-up. The scores of SOB changed significantly between the pre-surgery, 2 days after surgery, at the time of discharge and at 1 month follow-up ( F=3.582 P=0.016). The type of surgery, i.e. lobectomy versus wedge resection, was a significant risk factor. There was a significant correlation between SOB at discharge and QOL measures at 1 month follow-up (r=0.4,p=0.02).
Conclusion
Although not common at baseline, SOB is common after thoracic surgery, and is significantly associated with quality of life. Lung resection is apparently a significant risk factor. In addition to validate these findings, future study shall also investigate the effect of SOB on long-term complication and quality of life and define approaches of management to improve quality of life.
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P32.08 - Chest Pain After Thoracomy: A Prospective Pilot Study (ID 3863)
00:00 - 00:00 | Author(s): Jitian Zhang
- Abstract
Introduction
Post operation Chest pain is a common complication after thoracic surgery, but little is known the significance of Chest pain on the overall score of quality of life of the patient. The purpose of this study is to 1) exam the extent of chest pain at baseline, 2) changes after surgery in patients after thoracic surgery, and 3) the relationship between chest pain and post-surgical quality of life.
Methods
This is part of prospective pilot study of treatment toxicity, quality of life and biomarker study. Patients aged 18-year old and above requiring thoracotomy were eligible. The cough symptom was completed one day prior to, immediately after surgery as well as at the time of discharge. Patient, tumor and prior treatment factors were collected during the first visit of the treatment. Chest pain was evaluated by the treating physicians and graded according to NIH/NCI CTCAE v4.0. Quality of life was assessed by self-administrated questionnaires PROMIS tool per NIH recommendation. The variables of our interest included age, gender, Body mass index (can be calculated), weight/weight loss, KPS, comorbidity score, FEV1/FVC, COPD, tumor type, stage, histology, and prior treatments. Data are presented as mean (95% confidence interval) unless otherwise specified. Statistical significances were tested using T-pair test. P less than 0.05 were considered to be significant.
Results
Between September 2019 and August 2020, a total of 105 patients were scheduled to surgery and all of them were eligible for this study. 105 patients signed written consent forms were included in this exploratory analysis. Before surgery, 20/105 (19%:) patients had Chest Pain, while at 3 days after surgery, 71/105 (67.6%) had Chest pain. There was a no significant correlation between Pre surgery and post, such as ECOG(p=0.232), anxiety(p=0.16). At hospital discharge after surgery, FEV1, FEV1/FVC, and WBC were significantly associated with Chest pain, p=0.01,0.01, 0.02 respectively. while Hemoglobin (p=0.539), COPD(p=0.559), and Lymphoma(p=0.392) were not. At the time of discharge, the scores of Chest Pain was significantly associsated with Hoarseness (p=0.03). As 1 month after Surgery, there was a significant correlation between Chest pain and other factors such as Monocytes(p=0.04), Neutrophile.granulocyte (p=0.03), while Height (p=0.5), Family.history (p=0.463) were not.
Conclusion
Although not common at baseline, Chest pain is common after thoracic surgery, and is significantly associated with quality of life. Type of surgery seemed to be a risk factor. In addition to validate these findings, future study shall also investigate the effect of Chest pain on long-term complication and quality of life and define approaches of management to improve quality of life.
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P33 - Pathology - Immunotherapy Biomarker (ID 101)
- Event: WCLC 2020
- Type: Posters
- Track: Pathology, Molecular Pathology and Diagnostic Biomarkers
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P33.03 - Alteration of Circulating Blood Lymphocyte Subtypes Reveal Therapy Effect in Non-small Cell Lung Cancer (ID 3182)
00:00 - 00:00 | Author(s): Jitian Zhang
- Abstract
Introduction
Lung cancer is the leading mortality regarding cancer-related death worldwide. Radiotherapy (RT) and surgical resection (SR) as two main local therapies in NSCLC have either suppressive or stimulatory effects on the immune system. The abscopal effect induced by RT may be one of the positive consequences of immune regulation. It is widely reported that RT can reduce the circulating lymphocyte counts and tumor-infiltrating lymphocytes. Similarly, the rising numbers of circulating monocytes in the SR patients indicate the complicated immune regulation. It’s still unclear the mechanism involved in the systemic changes of immune cells in the blood. Peripheral blood lymphocyte subpopulations were useful markers for evaluating immune response in tumor patients. Hence, we aimed to systematically investigate the alteration of lymphocyte subpopulations during the local therapies to evaluate antitumor treatment effects.
Methods
Primary tumor patients treated with localized therapies were recruited to a prospective study for the peripheral blood collection. The following antibodies were used in the lymphocyte subtyping: CD11b, CD45, CD19, CD3, CD56, CD4, CD8a, and FOXP3. The staining cells were detected by flow cytometry and data were analyzed by the paired T-test. The percentage of Lymphocytes, Myeloid cells, B cells, T cells, Treg, CD8+ T cells, CD4+ T cells, NK cells, and NKT were examined. The baseline between RT and SR was analyzed by the unpaired T-test. P<0.05 was considered as statistical significance. We included RT and SR as they are the main local therapy to the patients with NSCLC.
Results
Between July 2019 and January 2020, a total of 119 patients eligible, including 57 RT patients and 29 SR patients with both blood collection with both Pre and End therapies.
Before local therapies, the percentage of total T cells in the RT group was significantly higher than SR (RT v.s SR mean:64.1 v.s 55.3, P=0.02) while CD8+ T cells (RT v.s SR mean:28.2 v.s 34.5, P=0.04)and Tregs (RT v.s SR mean:0.0 v.s 0.1, P=0.055) were lower. The baseline level of T cells and their subtypes showed a significant difference in these two group patients. After local therapies, myeloid Cells, lymphocytes, CD4+ T cells, CD8+ T cells, NK cells were significantly different.
In the RT group, lymphocytes (Pre-RT v.s End-RT mean:75.2 v.s 54.3, P=0.004) and B cells (Pre-RT v.s End-RT mean:12.6 v.s 8.0, P=0.03) were significantly decreased while other subpopulations didn’t show any significant difference after RT. Interestingly, in the SR group, there was a significant increase in CD4+ T cells (mean:59.0 v.s 62.1, p=0.02) a trend of reduction in CD8+ T cells (mean:34.5 v.s 32.0, p=0.055) after SR.
Conclusion
There are some different patterns of distribution in subtypes of leukocytes in operable and inoperable patients and between different local therapies. Both RT and SR changed the distribution of peripheral blood lymphocyte subpopulations. Further validation study is warranted to validate our findings particularly in circulating lymphocytes and B cells as a marker to evaluate immune status after RT, CD4+ T cells and CD8+ T cells after SR as well as their relationship with tumor microenvironment and implication for personalized care.
