Application value of different surgical approaches in NSCLC patients based on pain mediators and peripheral blood CTC levels
Yin Demeng
Yue Yinzi
Deng Nan
Zou Song
Huang Shuai
Zhai Yunyi
Qiao Yu
Abstract：Objective To investigate the effects of different surgical procedures for non-small cell lung cancer(NSCLC)on patients'pain mediators and circulating tumor cells(CTCs)in peripheral blood,providing a reference for clinical decision-making.Methods Clinical data of NSCLC patients admitted to the Department of Thoracic Surgery of our hospital from January 2018 to January 2020 were retrospectively analyzed.Patients were grouped by surgical procedure into a single-port group(uniportal thoracoscopic surgery)and a two-port group(two-port thoracoscopic surgery).Propensity score matching was used for 1∶1 matching between groups,and 60 pairs of data were successfully matched.Recorded and compared items included surgical indicators(time of operation,intraoperative blood loss,length of hospital stay),pain stress response indi-cators at 48 h and 72 h postoperatively(norepinephrine[NE],substance P[SP],cortisol[Cor]),peripheral blood CTC levels preoperatively and on postoperative day 5,tumor markers(carcinoembryonic antigen[CEA],cytokeratin 19 fragment[CYFRA21-1],neuron-specific enolase[NSE]),and long-term prognosis indicators(mortality,recurrence rate,overall survival[OS]).Results The single-port group had significantly shorter time of operation and length of hospital stay and less intraoperative blood loss than the two-port group(P＜0.05).Serum NE,SP,and Cor at 72 h postoperatively were lower than at 24 h in both groups,and levels in the single-port group were significantly lower than those in the two-port group(P＜0.05).On postoperative day 5,CTC levels in stage Ⅰ patients were(8.15±1.32)CTCs/mL in the single-port group and(8.27±1.21)CTCs/mL in the two-port group,with no significant difference(P=0.663);for stage Ⅱ patients,the values were(9.55±1.27)CTCs/mL in the single-port group and(9.31±1.07)CTCs/mL in the two-port group,with no significant difference(P=0.551).On postoperative day 5,CEA,CYFRA21-1,and NSE levels in both groups were sig-nificantly lower than preoperative levels(P＜0.05);comparisons of postoperative CEA,CYFRA21-1,and NSE between the two groups showed no significant differences(P＞0.05).At 5-year follow-up,mortality,recurrence rate,and OS showed no significant differences between the two groups(P＞0.05).Conclusion Uniportal thoracoscopic surgery has clear advantages in shortening the time of operation and length of hospital stay,reducing intraoperative blood loss and postopera-tive complication risk,and accelerating postoperative recovery.Uniportal and two-port thoracoscopic surgeries are compara-ble in reducing postoperative serum tumor marker levels and CTC levels,and the 5-year follow-up shows no significant difference in long-term prognosis between the two surgical procedures.
Keywords：Uniportal thoracoscopic surgeryTwo-port thoracoscopic surgeryNon-small cell lung cancerPain mediatorsCirculating tumor cells
Publication Date：2025-11-20
Online Publishing Date：2026-03-13(First online date of this platform, not the publication date of the document)
Pages：7( 108-114 )