Thesis (Ph.D)-Cairo University, 2024.

Bibliography: pages 95-116.

1-To assess the correlation between COVID 19 infection in advanced NSCLC patients and PDL1 expression with its impact on clinical outcome in the form of:
Response rate
Progression free survival (PFS).
Overall survival (OS).
Mortality rate and morbidity.
2-To assess the different clinicopathological characteristics of advanced NSCLC patients with COVID 19 infection and its impact on clinical outcome.
Patients and methods:
Study design:
A prospective cohort study was conducted in Medical Oncology departments, National Cancer Institute (NCI) and during the period from (April 2021- to October 2023). Recruitment of patients was over 6 months and they were being followed up for 24 months.
Patients:
Inclusion criteria:
All patients with advanced non-small cell lung cancer stage 3& 4.
Patients with COVID 19 infection must have a confirmatory positive SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR).
Patients with performance status (ECOG 0-2).
Exclusion criteria:
Patients with performance status (ECOG 3-5).
Patients with non-small cell lung cancer stage 1&2.
Methods:
The following data was collected:
Demographic and clinical features of the patients including age, sex, residency, smoking history, performance status and comorbidities.
Histopathological results.
Radiological studies.
Different lines of treatment received and the response to it.
All patients with COVID 19 infection received the treatment protocol which was approved by the Egyptian Ministry of Health.
Any active treatment (chemotherapy or radiotherapy) was being held for patients with COVID 19 infection until their nasopharyngeal swabs became negative for SARS-CoV-2 RNA by RT-PCR.
Molecular and Immunohistochemical Studies:
Nasopharyngeal & nasal swab specimens was collected for Nucleic acid amplification testing (NAAT), with a reverse-transcription polymerase chain reaction (RT-PCR) assay, to detect SARS-CoV-2 RNA.
Detection of PDL1 expression by immunohistochemistry.
Primary outcome parameters:
Overall survival (OS), starting from date of diagnosis until death or date of last visit.
Progression free survival (PFS), from the date of starting treatment to progressive disease by radiological assessment.
Secondary outcome parameters:
Mortality rate.
Morbidity rate.
Statistical analysis:
Data were collected, revised, coded and entered to the Statistical Package for Social Science (IBM SPSS) version 27. The quantitative data were presented as mean, standard deviations and ranges when parametric and median, inter-quartile range (IQR) when data found non-parametric. Also qualitative variables were presented as number and percentages.
The comparison between groups regarding qualitative data was done by using Chi-square test and/or Fisher exact test when the expected count in any cell found less than 5.
The comparison between two independent groups with quantitative data and parametric distribution was done by using Independent t-test while with non-parametric distribution were done by using Mann-Whitney test.
Spearman correlation coefficients were used to assess the correlation between two quantitative parameters in the same group.
Kaplan Meier analysis was used to assess the relation between overall survival and the other studied parameters using Log Rank Test.
The confidence interval was set to 95% and the margin of error accepted was set to 5%. So, the p-value was considered significant as the following:
P-value > 0.05: Non-significant (NS)
P-value < 0.05: Significant (S)
P-value < 0.01: Highly significant (HS).
Results:
We found that 19.2% of our patients had a negative PDL1 expression and 80.8% had a positive PDL1 expression.
Also we observed shorter PFS and OS for patients with COVID 19 infection compared to those without COVID 19 infection, indicating that patients with COVID 19 infection had higher mortality and morbidity.

يتصدر سرطان الرئة المركز الأول في اسباب الوفاه من السرطان فى العالم و على الرغم من تطور سبل العلاج الإ اننا نواجه معدلات متدنية من الشفاء ، مما يجعل البحث عن طريق للتنبؤ عن مدي الأستجابة لعلاج الكيميائي باستخدام الدلالات الجزئية و الطفرات الجينية حاجة ماسة .
قد شكل وباء كوفيد 19 تحديا كبيرا للأنظمة الصحيه على مستوى العالم مما ادى الى تأخير تشخيص وعلاج العديد من الامراض ولاسيما الأورام الخبيثه. ويعتبر مرضى سرطان الرئه اكثر عرضه للاصابه بالعدوى نظرا لضعف مناعتهم كعرض جانبى للادويه المضاده للسرطان مثل العلاج الكيميائى وغيره فهم ايضا يعانون من ضعف بوظائف التنفس.
وقد أجرينا هذه الدراسة الأستقدامية فى المعهد القومي للأورام – جامعه القاهرة و قد تضمنت الدراسة 130 مريض يعانون من سرطان الرئة المتقدم من نوع الخلايا الغير صغيرة و المترددين على المعهد فى الفترة من ابريل 2021 الى اكتوبر 2023 ، وذلك لمعرفة تأثير الأصابه بعدوى كوفيد 19 الفيروسية على هولاء المرضي وإرتباطها مع التعبير لرابطة الموت المبرمج (1).
وقد اظهر 19.2 % من المرضى نتائج سلبيه لرابطة الموت المبرمج (1) بينما اظهر 80.8 % من المرضى نتائج ايجابيه لرابطة الموت المبرمج (1).
وقد تبين من خلال الدراسة المرضي الذين يعانون من عدوى كوفيد 19 الفيروسية يمتنعون بمعدل البقاء خاليا من المرض 5 أشهر مقارنة ب 9 أشهر للمرضي للذين لايعانون من هذه العدوى بنسبة خطأ أقل من 0.001 و تمتع ايضا المرضي الذين يعانون من عدوى كوفيد 19 الفيروسية لمدة بقاء أحياء 10 أشهر مقارنة ب 13 شهر للمرضي الذين لا يعانون من هذه العدوى (نسبة خطأ اقل من 0.001).
وبناء على ذلك ننصح بالتالي:
أ‌- تطبيق تصميم الرسالة على عدد اكبر من المرضي لمعرفه افضل طرق الوقاية لمنع حدوث عدوى كوفيد 19 الفيروسية.
ب‌- خطوة مستقبلية لتحديد افضل برتوكولات العلاج الكيميائي لمرضي سرطان الرئة من نوع الخلايا الغير صغيرة فى حاله حدوث وباء كوفيد 19 .

Issues also as CD.

Text in English and abstract in Arabic & English.