Advertisement

Postinduction therapy pulmonary function retesting is necessary before surgical resection for non–small cell lung cancer

Published:December 22, 2021DOI:https://doi.org/10.1016/j.jtcvs.2021.12.030

      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

      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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Thoracic and Cardiovascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Van Meerbeeck J.P.
        • Kramer G.W.
        • Van Schil P.E.
        • Legrand C.
        • Smit E.F.
        • Schramel F.
        • et al.
        Randomized controlled trial of resection versus radiotherapy after induction chemotherapy in stage IIIA-N2 non–small-cell lung cancer.
        J Natl Cancer Inst. 2007; 99: 442-450
        • International Adjuvant Lung Cancer Trial Collaborative Group
        Cisplatin-based adjuvant chemotherapy in patients with completely resected non–small-cell lung cancer.
        N Engl J Med. 2004; 350: 351-360
        • Waller D.
        • Peake M.D.
        • Stephens R.J.
        • Gower N.H.
        • Milroy R.
        • Parmar M.K.
        • et al.
        Chemotherapy for patients with non-small cell lung cancer: the surgical setting of the Big Lung Trial.
        Eur J Cardiothorac Surg. 2004; 26: 173-182
        • Pisters K.M.
        • Ginsberg R.J.
        • Giroux D.J.
        • Putnam Jr., J.B.
        • Kris M.G.
        • Johnson D.H.
        • et al.
        Induction chemotherapy before surgery for early-stage lung cancer: a novel approach.
        J Thorac Cardiovasc Surg. 2000; 119: 429-439
        • Forde P.M.
        • Chaft J.E.
        • Smith K.N.
        • Anagnostou V.
        • Cottrell T.R.
        • Hellmann M.D.
        • et al.
        Neoadjuvant PD-1 blockade in resectable lung cancer.
        N Engl J Med. 2018; 378: 1976-1986
        • Yang C.F.
        • McSherry F.
        • Mayne N.R.
        • Wang X.
        • Berry M.F.
        • Tong B.
        • et al.
        Surgical outcomes after neoadjuvant chemotherapy and ipilimumab for non-small cell lung cancer.
        Ann Thorac Surg. 2018; 105: 924-929
        • McDonald S.
        • Rubin P.
        • Phillips T.L.
        • Marks L.B.
        Injury to the lung from cancer therapy: clinical syndromes, measurable endpoints, and potential scoring systems.
        Int J Radiat Oncol Biol Phys. 1995; 31: 1187-1203
        • Nishino M.
        • Giobbie-Hurder A.
        • Hatabu H.
        • Ramaiya N.H.
        • Hodi F.S.
        Incidence of programmed cell death 1 inhibitor–related pneumonitis in patients with advanced cancer: a systematic review and meta-analysis.
        JAMA Oncol. 2016; 2: 1607-1616
        • Martin J.
        • Ginsberg R.J.
        • Abolhoda A.
        • Bains M.S.
        • Downey R.J.
        • Korst R.J.
        • et al.
        Morbidity and mortality after neoadjuvant therapy for lung cancer: the risks of right pneumonectomy.
        Ann Thorac Surg. 2001; 72: 1149-1154
        • Albain K.S.
        • Swann R.S.
        • Rusch V.W.
        • Turrisi III, A.T.
        • Shepherd F.A.
        • Smith C.
        • et al.
        Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial.
        Lancet. 2009; 374: 379-386
        • Cerfolio R.J.
        • Talati A.
        • Bryant A.S.
        Changes in pulmonary function tests after neoadjuvant therapy predict postoperative complications.
        Ann Thorac Surg. 2009; 88: 930-936
        • Margaritora S.
        • Cesario A.
        • Cusumano G.
        • Cafarotti S.
        • Corbo G.M.
        • Ferri L.
        • et al.
        Is pulmonary function damaged by neoadjuvant lung cancer therapy? A comprehensive serial time-trend analysis of pulmonary function after induction radiochemotherapy plus surgery.
        J Thorac Cardiovasc Surg. 2010; 139: 1457-1463
        • Nomori H.
        • Shiraishi A.
        • Cong Y.
        • Shoji K.
        • Misawa M.
        • Sugimura H.
        • et al.
        Impact of induction chemoradiotherapy on pulmonary function after lobectomy for lung cancer.
        J Thorac Cardiovasc Surg. 2018; 155: 2129-2137
        • Brunelli A.
        • Kim A.W.
        • Berger K.I.
        • Addrizzo-Harris D.J.
        Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: diagnosis and management of lung cancer: American College of Chest Physicians evidence-based clinical practice guidelines.
        Chest. 2013; 143: e166S-e190S
        • Boushy S.F.
        • Billig D.M.
        • North L.B.
        • Helgason A.H.
        Clinical course related to preoperative and postoperative pulmonary function in patients with bronchogenic carcinoma.
        Chest. 1971; 59: 383-391
        • Gass G.D.
        • Olsen G.N.
        Preoperative pulmonary function testing to predict postoperative morbidity and mortality.
        Chest. 1986; 89: 127-135
        • Gopal R.
        • Starkschall G.
        • Tucker S.L.
        • Cox J.D.
        • Liao Z.
        • Hanus M.
        • et al.
        Effects of radiotherapy and chemotherapy on lung function in patients with non–small-cell lung cancer.
        Int J Radiat Oncol Biol Phys. 2003; 56: 114-120
        • Rivera M.P.
        • Detterbeck F.C.
        • Socinski M.A.
        • Moore D.T.
        • Edelman M.J.
        • Jahan T.M.
        • et al.
        Impact of preoperative chemotherapy on pulmonary function tests in resectable early-stage non-small cell lung cancer.
        Chest. 2009; 135: 1588-1595
        • Barnett S.A.
        • Rusch V.W.
        • Zheng J.
        • Park B.J.
        • Rizk N.P.
        • Plourde G.
        • et al.
        Contemporary results of surgical resection of non-small cell lung cancer after induction therapy: a review of 549 consecutive cases.
        J Thorac Oncol. 2011; 6: 1530-1536
        • Hanna N.
        • Johnson D.
        • Temin S.
        • Baker Jr., S.
        • Brahmer J.
        • Ellis P.M.
        • et al.
        Systemic therapy for stage IV non-small-cell lung cancer: American Society of Clinical Oncology clinical practice guideline update.
        J Clin Oncol. 2017; 35: 3484-3515
        • Fernando H.C.
        • Landreneau R.J.
        • Mandrekar S.J.
        • Hillman S.L.
        • Nichols F.C.
        • Meyers B.
        • et al.
        Thirty- and ninety-day outcomes after sublobar resection with and without brachytherapy for non–small cell lung cancer: results from a multicenter phase III study.
        J Thorac Cardiovasc Surg. 2011; 142: 1143-1151
        • Fernando H.C.
        • Timmerman R.
        American College of Surgeons Oncology Group Z4099/Radiation Therapy Oncology Group 1021: a randomized study of sublobar resection compared with stereotactic body radiotherapy for high-risk stage I non–small cell lung cancer.
        J Thorac Cardiovasc Surg. 2012; 144: S35-S38
        • Dindo D.
        • Demartines N.
        • Clavien P.A.
        Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004; 240: 205-213
        • Brunelli A.
        Preoperative functional workup for patients with advanced lung cancer.
        J Thorac Dis. 2016; 8: S840-S848
        • Takeda S.I.
        • Funakoshi Y.
        • Kadota Y.
        • Koma M.
        • Maeda H.
        • Kawamura S.
        • et al.
        Fall in diffusing capacity associated with induction therapy for lung cancer: a predictor of postoperative complication?.
        Ann Thorac Surg. 2006; 82: 232-236
        • Shin S.
        • Choi Y.S.
        • Jung J.J.
        • Im Y.
        • Shin S.H.
        • Kang D.
        • et al.
        Impact of diffusing lung capacity before and after neoadjuvant concurrent chemoradiation on postoperative pulmonary complications among patients with stage IIIA/N2 non-small-cell lung cancer.
        Respir Res. 2020; 21: 1-9
        • Suzuki Y.
        • Karayama M.
        • Uto T.
        • Fujii M.
        • Matsui T.
        • Asada K.
        • et al.
        Assessment of immune-related interstitial lung disease in patients with NSCLC treated with immune checkpoint inhibitors: a multicenter prospective study.
        J Thorac Oncol. 2020; 15: 1317-1327
        • Guyatt G.
        • Gutterman D.
        • Baumann M.H.
        • Addrizzo-Harris D.
        • Hylek E.M.
        • Phillips B.
        • et al.
        Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American College of Chest Physicians task force.
        Chest. 2006; 129: 174-181
        • Rosero I.D.
        • Ramírez-Vélez R.
        • Lucia A.
        • Martínez-Velilla N.
        • Santos-Lozano A.
        • Valenzuela P.L.
        • et al.
        Systematic review and meta-analysis of randomized, controlled trials on preoperative physical exercise interventions in patients with non-small-cell lung cancer.
        Cancers (Basel). 2019; 11: 944
        • Donington J.
        • Ferguson M.
        • Mazzone P.
        • Handy Jr., J.
        • Schuchert M.
        • Fernando H.
        • et al.
        American College of Chest Physicians and Society of Thoracic Surgeons consensus statement for evaluation and management for high-risk patients with stage I non-small cell lung cancer.
        Chest. 2012; 142: 1620-1635
        • Stefanelli F.
        • Meoli I.
        • Cobuccio R.
        • Curcio C.
        • Amore D.
        • Casazza D.
        • et al.
        High-intensity training and cardiopulmonary exercise testing in patients with chronic obstructive pulmonary disease and non-small-cell lung cancer undergoing lobectomy.
        Eur J Cardiothorac Surg. 2013; 44: e260-e265

      Linked Article

      • Commentary: Dum spiro spero
        The Journal of Thoracic and Cardiovascular SurgeryVol. 164Issue 2
        • Preview
          Dum 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.
        • Full-Text
        • PDF