Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea.
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Chest. 2020 Jun;157(6):1665-1673. doi: 10.1016/j.chest.2019.12.039. Epub 2020 Jan 25.
The risk stratification value of the 6-min walk test (6MWT) to decide the feasibility of surgical resection is not well elucidated in patients with non-small cell lung cancer (NSCLC) and moderately decreased lung function.
This study aimed to determine the role of the 6MWT in predicting postoperative cardiopulmonary complications in patients with NSCLC who underwent lobectomy and had moderately decreased lung function.
The data were obtained from a prospective cohort study called Coordinate Approach to Cancer Patient's Health for Lung Cancer (CATCH-LUNG). Patients who underwent lobectomy for NSCLC were classified into two groups according to predicted postoperative pulmonary function (low-risk group or moderate-risk group); each group was then further classified into short-distance (< 400 m) or long-distance (≥ 400 m) groups according to a 6-min walk distance. The main end point of this study was the incidence of postoperative cardiopulmonary complications occurring within the first 30 postoperative days. A multivariable logistic regression model was used to compare the postoperative cardiopulmonary complications among the four groups.
The adjusted ORs for any postoperative pulmonary complications, postoperative cardiac complications, and postoperative cardiopulmonary complications in patients with moderate-risk/short-distance relative to those with low-risk/long-distance were 10.26 (95% CI, 2.37-44.36), 5.65 (95% CI, 1.39-22.90), and 7.84 (95% CI, 2.24-27.46), respectively. However, these complications were not different between the patients with moderate-risk/long-term distance and those with low-risk/long-distance. Among patients in the moderate-risk group, those in the short-distance group had a significantly higher risk of postoperative cardiopulmonary complications compared with those in the long-distance group (adjusted OR, 4.95; 95% CI, 1.37-17.93).
Patients with NSCLC with moderate-risk/short-distance were at greater risk of developing postoperative cardiopulmonary complications; it may be feasible, however, for patients with NSCLC and moderate-risk/long-distance to undergo lobectomy compared with those with low-risk/long-distance. Our study suggests that the 6MWT could provide additional information in identifying optimal candidates for lung resection surgery of NSCLC.
ClinicalTrials.gov; No.: NCT03705546; URL: www.clinicaltrials.gov.
6 分钟步行试验（6MWT）在预测非小细胞肺癌（NSCLC）和中度肺功能下降患者手术切除可行性方面的风险分层价值尚未得到充分阐明。
本研究旨在确定 6MWT 在预测行肺叶切除术且中度肺功能下降的 NSCLC 患者术后心肺并发症中的作用。
本研究数据来自一项名为 Coordinate Approach to Cancer Patient's Health for Lung Cancer（CATCH-LUNG）的前瞻性队列研究。根据预测的术后肺功能，将接受肺叶切除术治疗 NSCLC 的患者分为低危组或中危组；每组再根据 6 分钟步行距离进一步分为短距离（<400 m）或长距离（≥400 m）组。本研究的主要终点是术后 30 天内发生的术后心肺并发症的发生率。采用多变量逻辑回归模型比较四组之间的术后心肺并发症。
与低危/长距离组相比，中危/短距离组患者的任何术后肺部并发症、术后心脏并发症和术后心肺并发症的调整后 OR 值分别为 10.26（95%CI，2.37-44.36）、5.65（95%CI，1.39-22.90）和 7.84（95%CI，2.24-27.46）。然而，中危/长距离组患者与低危/长距离组患者的这些并发症并无差异。在中危组患者中，与长距离组相比，短距离组患者术后心肺并发症的风险显著更高（调整后 OR，4.95；95%CI，1.37-17.93）。
中危/短距离 NSCLC 患者发生术后心肺并发症的风险更高；然而，与低危/长距离患者相比，中危/长距离患者行肺叶切除术可能更为可行。我们的研究表明，6MWT 可以提供额外的信息，帮助确定 NSCLC 肺切除术的最佳候选者。
ClinicalTrials.gov；注册号：NCT03705546；网址：www.clinicaltrials.gov。
