Postinduction therapy pulmonary function retesting is necessary before surgical resection for non–small cell lung cancer
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 induc...
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| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2022-08, Vol.164 (2), p.389-397.e7 |
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| container_title | The Journal of thoracic and cardiovascular surgery |
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| creator | Connolly, James G. Fiasconaro, Megan Tan, Kay See Cirelli, Michael A. Jones, Gregory D. Caso, Raul Mansour, Daniel E. Dycoco, Joseph No, Jae Seong Molena, Daniela Isbell, James M. Park, Bernard J. Bott, Matthew J. Jones, David R. Rocco, Gaetano |
| description | 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.
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 |
| doi_str_mv | 10.1016/j.jtcvs.2021.12.030 |
| format | Article |
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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.
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.
Reduced postinduction DLCO might predict perioperative outcomes. The use of repeat pulmonary function testing might identify patients at higher risk of morbidity or mortality.
[Display omitted]</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2021.12.030</identifier><identifier>PMID: 35086669</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Carbon Monoxide - metabolism ; Carcinoma, Non-Small-Cell Lung - pathology ; diffusing capacity of the lung for carbon monoxide ; DLCO ; Humans ; Lung ; Lung Neoplasms - pathology ; non–small cell lung cancer ; Pulmonary Diffusing Capacity ; pulmonary function testing ; Respiratory Function Tests ; Retrospective Studies</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2022-08, Vol.164 (2), p.389-397.e7</ispartof><rights>2021 The American Association for Thoracic Surgery</rights><rights>Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c459t-99ad571de45fe8776ffe45a19a3036c0e9d494480eea1be69919cc4209790d043</citedby><cites>FETCH-LOGICAL-c459t-99ad571de45fe8776ffe45a19a3036c0e9d494480eea1be69919cc4209790d043</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022522321018183$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35086669$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Connolly, James G.</creatorcontrib><creatorcontrib>Fiasconaro, Megan</creatorcontrib><creatorcontrib>Tan, Kay See</creatorcontrib><creatorcontrib>Cirelli, Michael A.</creatorcontrib><creatorcontrib>Jones, Gregory D.</creatorcontrib><creatorcontrib>Caso, Raul</creatorcontrib><creatorcontrib>Mansour, Daniel E.</creatorcontrib><creatorcontrib>Dycoco, Joseph</creatorcontrib><creatorcontrib>No, Jae Seong</creatorcontrib><creatorcontrib>Molena, Daniela</creatorcontrib><creatorcontrib>Isbell, James M.</creatorcontrib><creatorcontrib>Park, Bernard J.</creatorcontrib><creatorcontrib>Bott, Matthew J.</creatorcontrib><creatorcontrib>Jones, David R.</creatorcontrib><creatorcontrib>Rocco, Gaetano</creatorcontrib><title>Postinduction therapy pulmonary function retesting is necessary before surgical resection for non–small cell lung cancer</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>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.
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.
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.
Reduced postinduction DLCO might predict perioperative outcomes. The use of repeat pulmonary function testing might identify patients at higher risk of morbidity or mortality.
[Display omitted]</description><subject>Carbon Monoxide - metabolism</subject><subject>Carcinoma, Non-Small-Cell Lung - pathology</subject><subject>diffusing capacity of the lung for carbon monoxide</subject><subject>DLCO</subject><subject>Humans</subject><subject>Lung</subject><subject>Lung Neoplasms - pathology</subject><subject>non–small cell lung cancer</subject><subject>Pulmonary Diffusing Capacity</subject><subject>pulmonary function testing</subject><subject>Respiratory Function Tests</subject><subject>Retrospective Studies</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UctKAzEUDaJofXyBIPMDM95knlkoiPiCgi4U3IU0c6emTJOSzBTqyn_wD_0SU0eLbtwkIedxuecQckwhoUCL01ky69TSJwwYTShLIIUtMqLAy7io8udtMgJgLM4ZS_fIvvczACiB8l2yl-ZQFUXBR-T1wfpOm7pXnbYm6l7QycUqWvTt3BrpVlHTmwFy2OGaOo20jwwq9H6NT7CxDiPfu6lWsg00j4Mg_EfGmo-3dz-XbRspDEfbBwMljUJ3SHYa2Xo8-r4PyNP11ePlbTy-v7m7vBjHKst5F3Mu67ykNWZ5g1VZFk0TnpJymUJaKEBeZzzLKkCUdIIF55QrlbGQA4casvSAnA--i34yx1qh6ZxsxcLpeVhAWKnFX8ToFzG1S8EZrQDSYJAOBspZ7x02Gy0Fsa5CzMRXFWJdhaBMhCqC6uT32I3mJ_tAOBsIGJZfanTCK40hmVq7EKGorf53wCdd1qG6</recordid><startdate>20220801</startdate><enddate>20220801</enddate><creator>Connolly, James G.</creator><creator>Fiasconaro, Megan</creator><creator>Tan, Kay See</creator><creator>Cirelli, Michael A.</creator><creator>Jones, Gregory D.</creator><creator>Caso, Raul</creator><creator>Mansour, Daniel E.</creator><creator>Dycoco, Joseph</creator><creator>No, Jae Seong</creator><creator>Molena, Daniela</creator><creator>Isbell, James M.</creator><creator>Park, Bernard J.</creator><creator>Bott, Matthew J.</creator><creator>Jones, David R.</creator><creator>Rocco, Gaetano</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>20220801</creationdate><title>Postinduction therapy pulmonary function retesting is necessary before surgical resection for non–small cell lung cancer</title><author>Connolly, James G. ; 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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.
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.
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.
Reduced postinduction DLCO might predict perioperative outcomes. The use of repeat pulmonary function testing might identify patients at higher risk of morbidity or mortality.
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| ispartof | The Journal of thoracic and cardiovascular surgery, 2022-08, Vol.164 (2), p.389-397.e7 |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete; EZB Electronic Journals Library |
| subjects | Carbon Monoxide - metabolism Carcinoma, Non-Small-Cell Lung - pathology diffusing capacity of the lung for carbon monoxide DLCO Humans Lung Lung Neoplasms - pathology non–small cell lung cancer Pulmonary Diffusing Capacity pulmonary function testing Respiratory Function Tests Retrospective Studies |
| title | Postinduction therapy pulmonary function retesting is necessary before surgical resection for non–small cell lung cancer |
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