Ospedali Riuniti Ancona, Ancona, Italy.
Ann Thorac Surg. 2012 Jun;93(6):1796-800. doi: 10.1016/j.athoracsur.2012.02.068. Epub 2012 May 1.
This investigation evaluated whether the performance at a preoperative symptom-limited stair-climbing test was a prognostic factor in resected pathologic stage I non-small cell lung cancer (NSCLC).
Observational analysis was performed on a prospective database that included 296 patients who underwent pulmonary lobectomy for pathologic stage T1 N0 or T2 N0 NSCLC (2000 to 2008). Patients who received induction chemotherapy were excluded. Survival was calculated by the Kaplan-Meyer method. The log-rank test was used to assess differences in survival between groups. The relationships between survival and baseline and clinical variables were determined by Cox multivariate analyses.
Median follow-up was 43 months. The best cutoff associated with prognosis was an 18-meter stair climb. Median (months) survival and 5-year survival of patients who climbed more than 18 meters were significantly longer than those who climbed less than 18 meters (97 vs 74; 77% vs 54%, p=0.001). Cox regression model (hazard ratio) showed that climbing more than 18 meters (0.5; p=0.003), diffusion capacity of the lung for carbon monoxide (0.98; p=0.02), and pT stage (1.8; p=0.02) were independent prognostic factors. Patients who climbed less than 18 meters had increased deaths from cancer (24% vs 15%, p=0.1) or other causes (19% vs 9%, p=0.02).
Preoperative cardiopulmonary fitness is a significant prognostic factor in patients after resection for early-stage NSCLC. Interventions aimed at improving exercise tolerance can be useful to improve long-term prognosis after NSCLC operations.
本研究旨在评估术前症状限制登梯试验的表现是否为Ⅰ期非小细胞肺癌（NSCLC）切除术后的预后因素。
对一项包括 296 例因Ⅰ期 T1N0 或 T2N0 NSCLC 行肺叶切除术的患者前瞻性数据库进行观察性分析（2000 年至 2008 年）。排除接受诱导化疗的患者。通过 Kaplan-Meier 法计算生存。对数秩检验用于评估组间生存差异。通过 Cox 多变量分析确定生存与基线和临床变量的关系。
中位随访时间为 43 个月。与预后相关的最佳截距是 18 米登梯。超过 18 米的患者的中位（月）生存和 5 年生存率明显长于小于 18 米的患者（97 与 74；77%与 54%，p=0.001）。Cox 回归模型（风险比）显示，超过 18 米（0.5；p=0.003）、一氧化碳弥散量（0.98；p=0.02）和 pT 分期（1.8；p=0.02）是独立的预后因素。登梯少于 18 米的患者癌症死亡（24%与 15%，p=0.1）或其他原因（19%与 9%，p=0.02）死亡的风险增加。
术前心肺功能是早期 NSCLC 切除术后患者的重要预后因素。旨在提高运动耐量的干预措施可能有助于改善 NSCLC 手术后的长期预后。
