Lung Cancer: Lung Cancer I |

The Impact of Preoperative Diffusing Capacity on Prediction of Postoperative Life-Threatening Complications and Long-term Survival in Clinical Stage I Non-small Cell Lung Cancer FREE TO VIEW

Takeshi Mimura, MD; Yoshihiro Miyata, MD; Yuichiro Kai, MD; Masaoki Ito; Tsutani Yasuhiro; Aritochi Hattori, MD; Kazuya Takamochi, MD; Kenji Suzuki, MD; Morihito Okada, MD
Author and Funding Information

Hiroshima University, Hiroshima, Japan

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):705A. doi:10.1016/j.chest.2016.08.800
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: This study aimed to determine the significance of preoperative diffusing capacity of the lung for carbon monoxide (DLCO) in surgical outcomes in clinical stage I non-small cell lung cancer (NSCLC) patients.

METHODS: We performed a retrospective review of training and validation cohorts that underwent radical resection (R0) for clinical stage I NSCLC between January 2009 and December 2014 at two independent institutions. Each complication was classified according to the Clavien-Dindo classification of surgical complications. Receiver operating characteristic (ROC) curve analysis was performed to identify factors that could predict the incidence of postoperative complications. Several potential prognostic factors were analyzed with respect to outcomes including overall survival (OS).

RESULTS: The training cohort included 431 patients with a mean age of 67.7 years who underwent wedge resection (n=49), segmentectomy (n=118), lobectomy (n=264), and other procedures (n=6) for clinical stage IA (n=325) and stage IB (n=112) NSCLC. Postoperative major complications (Grade IVa or more; life-threatening complication requiring intensive care unit management) occurred in 8 patients (2%), and the postoperative 30-day mortality rate was 0.2% (n=1; acute exacerbation of idiopathic pulmonary fibrosis). The optimal cutoff value for prediction of postoperative complications determined using ROC curve analysis was 45.7% of DLCO (area under the curve [AUC], 0.954; 95% confidence interval [CI], 0.931-0.976; P< 0.001), which indicated 92.3% sensitivity and 100% specificity. The OS and disease-free survival (DFS) decreased to 68.3% and 63.7% at 5 years in patients with 50% or less of DLCO, compared with 92.3% and 85.2% in patients with more than 50% of DLCO (P<0.001, P<0.001, log-lank, respectively). Multivariate survival analysis using Cox's regression model revealed that less than 50% of DLCO was an independent predictor for OS (hazard ratio 4.21, P=0.001) and DFS (hazard ratio 3.44, P=0.001). In a validation cohort consisting of 784 patients, similar results were obtained showing that less than 50% of DLCO was an independent predictor for postoperative complications and OS (odds ratio 4.28, 95% CI, 1.40-12.96, P=0.010; hazard ratio 2.32, 95% CI, 1.37-3.91, P=0.002, respectively).

CONCLUSIONS: The preoperative diffusing capacity was an important predictive factor for not only postoperative life-threatening morbidity but also long-term survival in patients with clinical stage I NSCLC who were amenable to curative surgery.

CLINICAL IMPLICATIONS: Our data suggest the value of preoperative diffusing capacity in predicting postoperative short- and long-term outcomes and could aid in the selection of a surgical procedure including sublobar resection.

DISCLOSURE: The following authors have nothing to disclose: Takeshi Mimura, Yoshihiro Miyata, Yuichiro Kai, Masaoki Ito, Tsutani Yasuhiro, Aritochi Hattori, Kazuya Takamochi, Kenji Suzuki, Morihito Okada

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