Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, K1H 8L6, Canada.
Division of General Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Canada.
Lung. 2020 Dec;198(6):973-981. doi: 10.1007/s00408-020-00395-6. Epub 2020 Oct 9.
Up to 50% of patients suffer short-term postoperative adverse events (AEs) and metastatic recurrence in the long-term following curative-intent lung cancer resection. The association between AEs, particularly infectious in nature, and disease recurrence is controversial. We sought to evaluate the association of postoperative AEs on risk of developing recurrence and recurrence-free survival (RFS) following curative-intent lung resection surgery.
All lung cancer resections at a single institution (January 2008-July 2015) were included, with prospective collection of AEs using the Thoracic Morbidity & Mortality System. Cox proportional hazards models were used to estimate the effect of AEs on recurrence, with results presented as hazard ratio (HR) with 95% confidence interval (CI). An a priori, clinically driven approach to predictor variable selection was used. Kaplan-Meier curves were used examine the relationship between AE and RFS. p < 0.05 was considered statistically significant.
892 patients underwent curative-intent resection. 342 (38.3%) patients experienced an AE; 69 (7.7%) patients developed infectious AEs. 17.6% (n = 157) of patients had disease recurrence after mean follow-up of 26.5 months. Severe (Grade IV) AEs were associated with increased risk of recurrence (3.40; 95% CI 1.56-7.41) and a trend to decreased RFS. Major infectious AEs were associated with increased risk of recurrence (HR 1.71; CI 1.05-2.8) and earlier time to recurrence (no infectious AE 66 months, minor infectious 41 months, major infectious 54 months; p = 0.02).
For patients undergoing curative-intent lung cancer resection, postoperative AEs associated with critical illness or major infection were associated with increased risk of oncologic recurrence.
高达 50%的患者在接受根治性肺癌切除术后的短期和长期内会发生不良事件（AE）和转移性复发。AE，特别是感染性的AE与疾病复发之间的关联存在争议。我们旨在评估术后 AE 与根治性肺癌切除术后发生复发和无复发生存（RFS）的风险之间的关系。
纳入单机构所有接受肺癌切除术的患者（2008 年 1 月至 2015 年 7 月），前瞻性地使用胸部发病率和死亡率系统收集 AE。使用 Cox 比例风险模型估计 AE 对复发的影响，结果表示为危险比（HR）和 95%置信区间（CI）。采用临床驱动的预测变量选择方法。使用 Kaplan-Meier 曲线来检查 AE 与 RFS 之间的关系。p<0.05 被认为具有统计学意义。
892 例患者接受了根治性切除术。342 例（38.3%）患者发生了 AE；69 例（7.7%）患者发生了感染性 AE。在平均随访 26.5 个月后，17.6%（n=157）的患者发生疾病复发。严重（IV 级）AE 与复发风险增加相关（3.40；95%CI 1.56-7.41），且 RFS 呈下降趋势。主要感染性 AE 与复发风险增加相关（HR 1.71；CI 1.05-2.8）和更早的复发时间（无感染性 AE 66 个月，轻度感染性 AE 41 个月，重度感染性 AE 54 个月；p=0.02）。
对于接受根治性肺癌切除术的患者，与重病或严重感染相关的术后 AE 与肿瘤复发风险增加相关。
