早期慢性阻塞性肺疾病患者肺癌手术后肺部并发症的发生率及危险因素
Prevalence of and risk factors for postoperative pulmonary complications after lung cancer surgery in patients with early-stage COPD.
作者信息
Kim Eun Sun, Kim Young Tae, Kang Chang Hyun, Park In Kyu, Bae Won, Choi Sun Mi, Lee Jinwoo, Park Young Sik, Lee Chang-Hoon, Lee Sang-Min, Yim Jae-Joon, Kim Young Whan, Han Sung Koo, Yoo Chul-Gyu
机构信息
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
出版信息
Int J Chron Obstruct Pulmon Dis. 2016 Jun 16;11:1317-26. doi: 10.2147/COPD.S105206. eCollection 2016.
PURPOSE
This study aimed to investigate whether the prevalence of postoperative pulmonary complications (PPCs) in patients with non-small-cell lung cancer (NSCLC) is even higher in the early stages of COPD than in such patients with normal lung function and to verify the usefulness of symptom- or quality of life (QoL)-based scores in predicting risk for PPCs.
PATIENTS AND METHODS
Patients undergoing pulmonary resection for NSCLC between July 2012 and October 2014 were prospectively enrolled. Preoperative measurements of lung function, dyspnea, and QoL, operative characteristics, PPCs, duration of postoperative hospitalization, and in-hospital mortality were assessed.
RESULTS
Among 351 consecutive patients with NSCLC, 343 patients with forced expiratory volume in 1 second (FEV1) ≥70% of predicted value were enrolled. At least one PPC occurred in 57 (16.6%) patients. Prevalence of PPC was higher in patients with COPD (30.1%) than in those with normal spirometry (10.0%; P<0.001). However, in patients with COPD, the prevalence of PPC was not different in patients with FEV1 ≥70% compared to those with FEV1 <70% and between group A (low risk and less symptoms) and group B (low risk and more symptoms) patients with COPD, based on the new Global initiative for chronic Obstructive Lung Disease 2011 guidelines. In patients with COPD, body mass index (odds ratio [OR]: 0.80, P=0.007), carbon monoxide diffusing capacity of the lung (DLCO), % predicted value (OR: 0.97, P=0.024), and operation time (OR: 1.01, P=0.003), but not COPD assessment test or St George Respiratory Questionnaire scores, were significantly associated with PPCs.
CONCLUSION
Even in patients with early-stage COPD, the prevalence of PPCs is higher than in patients with NSCLC with normal spirometry. However, this rate is not different between group A and group B patients with COPD. In accordance with this, scores based on symptoms or QoL are not predictors of risk of PPCs in patients with early-stage COPD.
目的
本研究旨在调查非小细胞肺癌（NSCLC）患者中，慢性阻塞性肺疾病（COPD）早期患者术后肺部并发症（PPCs）的发生率是否高于肺功能正常的此类患者，并验证基于症状或生活质量（QoL）的评分在预测PPCs风险方面的有效性。
患者与方法
前瞻性纳入2012年7月至2014年10月期间接受NSCLC肺切除术的患者。评估术前肺功能、呼吸困难和QoL的测量值、手术特征、PPCs、术后住院时间和院内死亡率。
结果
在351例连续的NSCLC患者中，纳入了343例1秒用力呼气量（FEV1）≥预测值70%的患者。57例（16.6%）患者发生了至少一种PPC。COPD患者中PPC的发生率（30.1%）高于肺功能正常者（10.0%；P<0.001）。然而，在COPD患者中，根据2011年慢性阻塞性肺疾病全球倡议新指南，FEV1≥70%的患者与FEV1<70%的患者之间，以及COPD的A组（低风险且症状较少）和B组（低风险且症状较多）患者之间，PPC的发生率并无差异。在COPD患者中，体重指数（优势比[OR]：0.80，P=0.007）、肺一氧化碳弥散量（DLCO）、预测值百分比（OR：0.97，P=0.024）和手术时间（OR：1.01，P=0.003）与PPCs显著相关，但COPD评估测试或圣乔治呼吸问卷评分则不然。
结论
即使在COPD早期患者中，PPCs的发生率也高于肺功能正常的NSCLC患者。然而，COPD的A组和B组患者之间这一发生率并无差异。据此，基于症状或QoL的评分并非COPD早期患者PPCs风险的预测指标。
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