Matsuzaki Asuka, Hashimoto Naozumi, Okachi Shotaro, Taniguchi Tetsuo, Kawaguchi Koji, Fukui Takayuki, Wakai Kenji, Yokoi Kohei, Hasegawa Yoshinori
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Respir Investig. 2016 May;54(3):184-92. doi: 10.1016/j.resinv.2015.11.006. Epub 2015 Dec 21.
Previously, it has been shown that using a fixed ratio of FEV1/FVC of 0.7 to classify airway obstruction could not predict survival outcomes in lung cancer patients undergoing thoracic surgery. We demonstrated that use of the lower limit of normal (LLN) of FEV1/FVC may allow better risk stratification for postoperative outcomes in patients with chronic obstructive pulmonary disease (COPD) patients. Nevertheless, it remained unclear whether survival outcomes in this population could be predicted by LLN-defined airway obstruction.
To evaluate the clinical relevance of LLN-defined airway obstruction to survival outcomes.
The clinical relevance of LLN-defined airway obstruction was analyzed and compared in 699 subjects, using Kaplan-Meier curves and the log-rank test. A Cox regression model was used to explore prognostic risk factors.
One hundred-and-seventy-eight subjects were assigned to the below-LLN group, in which airflow obstruction determined by the FEV1/FVC ratio was below the LLN. Five hundred-and-twenty-one subjects were assigned to the above-LLN group. The below-LLN group had a worse overall survival (OS) and disease-free survival (DFS) than the above-LLN group. The diffusing capacity of the lung for carbon monoxide and the ratio of the inspiratory capacity divided to the total lung capacity were independent risk factors for OS and DFS.
A standardized assessment of LLN-defined airway obstruction may allow risk stratification for survival likelihood in lung cancer patients who undergo thoracic surgery.
此前研究表明，采用固定的1秒用力呼气容积/用力肺活量（FEV1/FVC）比值0.7来界定气道阻塞，无法预测接受胸外科手术的肺癌患者的生存结局。我们证明，使用FEV1/FVC的正常下限（LLN）可能会为慢性阻塞性肺疾病（COPD）患者的术后结局提供更好的风险分层。然而，尚不清楚该人群的生存结局是否可通过由LLN界定的气道阻塞来预测。
评估由LLN界定的气道阻塞与生存结局的临床相关性。
使用Kaplan-Meier曲线和对数秩检验，对699名受试者中由LLN界定的气道阻塞的临床相关性进行分析和比较。采用Cox回归模型探索预后风险因素。
178名受试者被归入LLN以下组，该组中由FEV1/FVC比值确定的气流阻塞低于LLN。521名受试者被归入LLN以上组。LLN以下组的总生存期（OS）和无病生存期（DFS）均比LLN以上组差。肺一氧化碳弥散量以及吸气量与肺总量的比值是OS和DFS的独立危险因素。
对由LLN界定的气道阻塞进行标准化评估，可能会对接受胸外科手术的肺癌患者的生存可能性进行风险分层。
