Department of Urology, Faculty of Medicine, University of Tsukuba, Japan.
Jpn J Clin Oncol. 2019 Dec 27;49(12):1151-1156. doi: 10.1093/jjco/hyz103.
We aimed to compare the diffusion capacity of carbon monoxide (DLCO), which was adjusted using the two equations the Cotes method and the Dinakara method, to assess bleomycin-induced lung injury in testicular cancer patients preparing for post-chemotherapy surgery.
Between November 1990 and October 2018, 89 patients with advanced testicular cancer were recruited into the study. All patients received chemotherapy and underwent DLCO measurements using the single-breath technique prior to surgery for residual tumor removal.
The mean DLCO adjusted for hemoglobin using the Cotes and Dinakara methods was 69.5% and 86.0%, respectively (P < 0.001). According to the Cotes method, adjusted DLCO was severely diminished to below 65% in 40 patients (45%), whereas this proportion was only 16% according to the Dinakara method. We observed a significant correlation between hemoglobin levels and DLCO adjusted using the Cotes method (P < 0.001), but not using the Dinakara method. Four patients received a clinical diagnosis of bleomycin-induced pneumonitis (BIP), and all patients recovered after oral steroid therapy or observation. The DLCO adjusted by either methods was not well correlated with the development of BIP. No patients had major postoperative respiratory complications.
We found that Cotes-adjusted DLCO may be influenced by anemia. We recommend the addition of Dinakara-adjusted DLCO, along with chest computed tomography, for preoperative risk assessment.
我们旨在比较使用 Cotes 法和 Dinakara 法调整后的一氧化碳弥散量（DLCO），以评估准备化疗后手术的睾丸癌患者接受博来霉素诱导的肺损伤。
1990 年 11 月至 2018 年 10 月期间，共有 89 例晚期睾丸癌患者纳入研究。所有患者均接受化疗，并在手术切除残留肿瘤前进行了单次呼吸技术的 DLCO 测量。
使用 Cotes 和 Dinakara 法分别对血红蛋白进行调整后的平均 DLCO 分别为 69.5%和 86.0%（P<0.001）。根据 Cotes 法，40 例患者（45%）的调整后 DLCO 严重降低至低于 65%，而根据 Dinakara 法，这一比例仅为 16%。我们观察到血红蛋白水平与 Cotes 法调整后的 DLCO 之间存在显著相关性（P<0.001），但与 Dinakara 法无关。有 4 例患者被临床诊断为博来霉素诱导性肺炎（BIP），所有患者在接受口服类固醇治疗或观察后均康复。两种方法调整后的 DLCO 与 BIP 的发生相关性不佳。无患者发生重大术后呼吸并发症。
我们发现 Cotes 调整后的 DLCO 可能受到贫血的影响。我们建议在术前风险评估中加入 Dinakara 调整后的 DLCO 以及胸部计算机断层扫描。
