Clinical significance of postoperative pulmonary complications in elderly patients with lung cancer.
Clinical significance of postoperative pulmonary complications in elderly patients with lung cancer.
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DOI：
10.1093/icvts/ivac153
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发表时间：
2022-07-09
影响因子：
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越来越多的老年患者免疫受损、营养不良和合并症被认为是外科手术的候选对象。本研究旨在明确老年肺癌患者术后肺部并发症的预测因素及对预后的影响。这项回顾研究包括了2005年至2019年间因非小细胞肺癌而接受完整解剖肺切除术的188例患者(≥75 Year)。术后30天内发生的肺部并发症按≥II分类进行评估。多因素Logistic回归分析和COX比例风险模型用于分析并发症的预测因素和预后影响。电视胸腔镜术154例(81.9%)。90天的死亡率为0.5%。术后肺部并发症29例(15.4%)，包括漏气、肺炎、痰浊、肺不张、支气管胸膜瘘、脓胸等。较低的预后营养指数(45)和较长的手术时间是肺部并发症的独立预测因素，33.3%的患者同时经历这两个因素。中位随访48个 月，有肺部并发症患者的5年总生存率和无复发生存率显著低于无肺部并发症患者(54.4%比81.5%和41.2%比74.9%)。肺部并发症与总生存率和无复发生存率[风险比(95%可信区间)：1.97(1.0 1~3.6 6)，P = 0.047和2.35(1.2 8~4.12)，P = 0.007]以及病理分期和癌胚抗原水平显著相关。术后肺部并发症与较低的预后营养指数和较长的手术时间相关，是老年患者独立的不良预后因素。肺癌是全球癌症相关死亡的主要原因[1]，手术切除仍然是局部疾病的标准治疗方法。
An increasing number of elderly patients with impaired immunity, malnutrition and comorbidities are considered surgical candidates. This study aimed to clarify the predictive factors and prognostic impact of postoperative pulmonary complications in elderly patients with lung cancer. This retrospective study included 188 patients (≥75 years) who underwent complete anatomical lung resection for non-small cell lung cancer between 2005 and 2019. Postoperative pulmonary complications graded ≥II in the Clavien-Dindo classification, occurring within 30-day post-surgery were evaluated. Multivariate logistic regression analyses and Cox proportional hazard models were used to analyse predictors and prognostic impact of complications. Video-assisted thoracoscopic surgery was performed in 154 patients (81.9%). The 90-day mortality rate was 0.5%. Postoperative pulmonary complications including air leak, pneumonia, sputum retention, atelectasis, bronchopleural fistula and empyema occurred in 29 patients (15.4%). A lower prognostic nutritional index (<45) and longer operative time were independent predictive factors of pulmonary complications, with 33.3% of patients experiencing both factors. Following a median follow-up of 48 months, the 5-year overall and relapse-free survival rates were significantly worse in patients with pulmonary complications than in those without them (54.4% vs 81.5% and 41.2% vs 74.9%). Pulmonary complications were significantly associated with worse overall and relapse-free survival [hazard ratio (95% confidence interval): 1.97 (1.01–3.66), P = 0.047 and 2.35 (1.28–4.12), P = 0.007, respectively] along with pathologic stage and carcinoembryonic antigen levels. Postoperative pulmonary complications are associated with a lower prognostic nutritional index and prolonged operative time; the complications are independent adverse prognostic factors in elderly patients. Lung cancer is the leading cause of cancer-related death worldwide [1], and surgical resection remains the standard treatment for localized diseases.
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影响因子：
1.2
作者：
Ichinokawa, Hideomi;Takamochi, Kazuya;Suzuki, Kenji
通讯作者：
Suzuki, Kenji
影响因子：
--
作者：
Shiono, Satoshi;Abiko, Masami;Sato, Toru
通讯作者：
Sato, Toru
影响因子：
1.2
作者：
Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery;Shimizu H;Okada M;Toh Y;Doki Y;Endo S;Fukuda H;Hirata Y;Iwata H;Kobayashi J;Kumamaru H;Miyata H;Motomura N;Natsugoe S;Ozawa S;Saiki Y;Saito A;Saji H;Sato Y;Taketani T;Tanemoto K;Tangoku A;Tatsuishi W;Tsukihara H;Watanabe M;Yamamoto H;Minatoya K;Yokoi K;Okita Y;Tsuchida M;Sawa Y
通讯作者：
Sawa Y
影响因子：
2.5
作者：
Katayama H;Kurokawa Y;Nakamura K;Ito H;Kanemitsu Y;Masuda N;Tsubosa Y;Satoh T;Yokomizo A;Fukuda H;Sasako M
通讯作者：
Sasako M
影响因子：
20.4
作者：
Goldstraw, Peter;Crowley, John;Sobin, Leslie
通讯作者：
Sobin, Leslie