6分钟步行试验结果是手术治疗的非小细胞肺癌的独立预后因素。
Result of the 6-min walk test is an independent prognostic factor of surgically treated non-small-cell lung cancer.
作者信息
Marjanski Tomasz, Badocha Michal, Wnuk Damian, Dziedzic Robert, Ostrowski Marcin, Sawicka Wioletta, Rzyman Witold
机构信息
Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland.
Department of Probability and Biomathematics, Gdańsk University of Technology, Gdansk, Poland.
出版信息
Interact Cardiovasc Thorac Surg. 2019 Mar 1;28(3):368-374. doi: 10.1093/icvts/ivy258.
OBJECTIVES
Pathological tumour, node and metastasis (TNM) stage remains the most significant prognostic factor of non-small-cell lung cancer (NSCLC). Meanwhile, age, gender, pulmonary function tests, the extent of surgical resection and the presence of concomitant diseases are commonly used to complete the prognostic profile of the patient with early stage of NSCLC. The aim of this study is to assess how the result of a 6-min walk test (6MWT) further assists in predicting the prognosis of NSCLC surgical candidates.
METHODS
Six hundred and twenty-four patients who underwent surgical treatment for NSCLC between April 2009 and October 2011 were enrolled in this study. All patients were accepted for surgery on the basis of a standard evaluation protocol. Additionally, patients completed the 6MWT on the day before the surgery, and threshold values of the test were assessed based on both the Akaike information criterion and the coefficient of determination R2. Cox proportional hazards regression analysis was used to analyse the effect of important prognostic factors on the overall survival.
RESULTS
Three hundred and ninety men and 234 women with a mean age of 64 years underwent radical surgical treatment for primary lung cancer. Five hundred and twenty-five lobectomies (84%), 77 pneumonectomies (12%) and 24 (4%) lesser resections were performed. Three hundred and thirty-one patients (53%) were treated for stage I NSCLC, 191 patients (31%) for stage II and 102 patients (16%) for stages IIIA-IV. A distance of 525 m in the 6MWT [hazard ratio (HR) = 0.57, 95% confidence interval (CI) 0.41-0.78, P < 0.001] was the threshold value differentiating the patients' prognoses (P < 0.001). Using the Cox proportional hazards regression analysis, pathological TNM stage (IIA: HR = 1.87, 95% CI 1.95-2.92, P = 0.006; IIB: HR = 2.03, 95% CI 1.23-3.37, P = 0.006; IIIA-IV: HR = 2.37, 95% CI 1.49-3.75, P < 0.001), male gender (HR = 1.88, 95% CI 1.26-2.79, P = 0.001), pneumonectomy (HR = 1.78, 95% CI 1.17-2.70, P < 0.001) and the results of the 6MWT (HR = 0.50, 95% CI 0.36-0.70, P < 0.001) were considered as independent predictive factors of overall survival.
CONCLUSIONS
The result of a 6MWT is an independent and convenient prognostic factor of surgically treated non-small-cell lung cancer.
目的
病理肿瘤、淋巴结及转移（TNM）分期仍是非小细胞肺癌（NSCLC）最重要的预后因素。同时，年龄、性别、肺功能检查、手术切除范围及合并疾病的存在情况常用于完善早期NSCLC患者的预后评估。本研究旨在评估6分钟步行试验（6MWT）结果如何进一步辅助预测NSCLC手术候选患者的预后。
方法
纳入2009年4月至2011年10月间接受NSCLC手术治疗的624例患者。所有患者均根据标准评估方案接受手术。此外，患者在手术前一天完成6MWT，并基于赤池信息准则和决定系数R2评估试验阈值。采用Cox比例风险回归分析来分析重要预后因素对总生存的影响。
结果
390例男性和234例女性，平均年龄64岁，接受了原发性肺癌根治性手术治疗。共进行了525例肺叶切除术（84%）、77例全肺切除术（12%）和24例（4%）较小范围切除术。331例（53%）患者为I期NSCLC，191例（31%）为II期，102例（16%）为IIIA-IV期。6MWT中525米的距离[风险比（HR）= 0.57，95%置信区间（CI）0.41 - 0.78，P < 0.001]是区分患者预后的阈值（P < 0.001）。使用Cox比例风险回归分析，病理TNM分期（IIA期：HR = 1.87，95% CI 1.95 - 2.92，P = 0.006；IIB期：HR = 2.03，95% CI 1.23 - 3.37，P = 0.006；IIIA-IV期：HR = 2.37，95% CI 1.49 - 3.75，P < 0.001）、男性性别（HR = 1.88，95% CI 1.26 - 2.79，P = 0.001）、全肺切除术（HR = 1.78，95% CI 1.17 - 2.70，P < 0.001）和6MWT结果（HR = 0.50，95% CI 0.36 - 0.70，P < 0.001）被视为总生存时间的独立预测因素。
结论
6MWT结果是手术治疗非小细胞肺癌的一个独立且便捷的预后因素。
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