Abstract
Objective
Pretreatment-predicted postoperative diffusing capacity of the lung for carbon monoxide
(DLCO) has been associated with operative mortality in patients who receive induction
therapy for resectable non–small cell lung cancer (NSCLC). It is unknown whether a
reduction in pulmonary function after induction therapy and before surgery affects
the risk of morbidity or mortality. We sought to determine the relationship between
induction therapy and perioperative outcomes as a function of postinduction pulmonary
status in patients who underwent surgical resection for NSCLC.
Methods
We retrospectively reviewed data for 1001 patients with pathologic stage I, II, or
III NSCLC who received induction therapy before lung resection. Pulmonary function
was defined according to American College of Surgeons Oncology Group major criteria:
DLCO ≥50% = normal; DLCO <50% = impaired. Patients were categorized into 5 subgroups
according to combined pre- and postinduction DLCO status: normal-normal, normal-impaired,
impaired-normal, impaired-impaired, and preinduction only (without postinduction pulmonary
function test measurements). Multivariable logistic regression was used to quantify
the relationship between DLCO categories and dichotomous end points.
Results
In multivariable analysis, normal-impaired DLCO status was associated with an increased
risk of respiratory complications (odds ratio, 2.29 [95% CI, 1.12-4.49]; P = .02) and in-hospital complications (odds ratio, 2.83 [95% CI, 1.55-5.26]; P < .001). Type of neoadjuvant therapy was not associated with an increased risk of
complications, compared with conventional chemotherapy.
Conclusions
Reduced postinduction DLCO might predict perioperative outcomes. The use of repeat
pulmonary function testing might identify patients at higher risk of morbidity or
mortality.
Graphical abstract
Graphical Abstract
Key Words
Abbreviations and Acronyms:
ACCP (American College of Chest Physicians), ACOSOG (American College of Surgeons Oncology Group), ANCOVA (analysis of covariance), DLCO (diffusing capacity of the lung for carbon monoxide), FEV1 (forced expiratory volume in 1 second), ICI (immune checkpoint inhibitor), IQR (interquartile range), LOS (length of stay), NSCLC (non–small cell lung cancer), PFT (pulmonary function test), ppo (predicted postoperative)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 22, 2021
Accepted:
December 15,
2021
Received in revised form:
December 9,
2021
Received:
October 27,
2020
Footnotes
This work was supported, in part, by the National Institutes of Health/National Cancer Institute (P30 CA008748 and T32 CA009501).
Identification
Copyright
© 2021 by The American Association for Thoracic Surgery
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- Commentary: Dum spiro speroThe Journal of Thoracic and Cardiovascular SurgeryVol. 164Issue 2
- PreviewDum spiro spero is a Latin phrase that translates to, “while I breathe, I hope,” as the verb spiro means both “to breathe” and “to live.” Similarly, the Sanskrit and Hindi word prana, the Hebrew word ruach, and the Chinese word qi all represent a duality of breath and life. Despite clearly different etymological origins, these words communicate the idea of the literal and figurative association between breathing, hope, and life. However, the association between breathing, hope, and life are not just a theoretical concept.
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