Gong Jialin, Wang Xiaofei, Liu Zuo, Yao Shuang, Xiao Zengtuan, Zhang Mengzhe, Zhang Zhenfa
Department of Lung Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
J Thorac Dis. 2021 Feb;13(2):847-860. doi: 10.21037/jtd-20-2740.
Surgical treatment of lung cancer is one of the important treatments for early-stage non-small cell lung cancer (NSCLC). However, arrhythmia, especially atrial fibrillation (AF) and supraventricular arrhythmia, are quite common among patients after surgical treatment of lung cancer. The impact of postoperative arrhythmia (PA) on survival is rarely reported. Our aim was to evaluate the risk factors of PA and its impact on overall survival (OS) after lung cancer surgery.
A total of 344 patients diagnosed with NSCLC who underwent lung cancer surgery were enrolled in this study. These patients were divided into two groups based on the occurrence of PA. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors of PA. The Kaplan-Meier method was applied to show the OS differences between the two groups.
The incidence of PA was 16% (55/344). Among these 55 patients, 20 had AF, 30 had sinus tachycardia, and 5 had premature beats. A total of 332 patients underwent lung cancer radical resection. Operation type (P<0.001), preoperative abnormal ECG (P=0.032), transfusion (P=0.016), postoperative serum potassium concentration (P=0.001) and clinical stage (P<0.05) were risk factors for PA. PA (HR 2.083, 95% CI, 1.334-3.253; P=0.001), age (HR 1.543, 95% CI, 1.063-2.239; P=0.025) and mediastinal lymph node metastasis (HR 2.655, 95% CI, 1.809-3.897; P<0.001) were independent prognostic risk factors for OS by multivariate cox analysis.
We identified PA as an independent prognostic risk factor to predict poor OS in patients who underwent lung cancer surgery and had risk factors for PA. We therefore provides guidance for PA in improving the prognosis of lung cancer patients.
肺癌手术是早期非小细胞肺癌（NSCLC）的重要治疗方法之一。然而，心律失常，尤其是心房颤动（AF）和室上性心律失常，在肺癌手术后患者中相当常见。术后心律失常（PA）对生存的影响鲜有报道。我们的目的是评估PA的危险因素及其对肺癌手术后总生存（OS）的影响。
本研究纳入了344例诊断为NSCLC并接受肺癌手术的患者。根据PA的发生情况将这些患者分为两组。进行单因素和多因素逻辑回归分析以确定PA的危险因素。采用Kaplan-Meier法显示两组之间的OS差异。
PA的发生率为16%（55/344）。在这55例患者中，20例有AF，30例有窦性心动过速，5例有早搏。共有332例患者接受了肺癌根治性切除术。手术类型（P<0.001）、术前心电图异常（P=0.032）、输血（P=0.016）、术后血清钾浓度（P=0.001）和临床分期（P<0.05）是PA的危险因素。通过多因素cox分析，PA（HR 2.083，95%CI，1.334 - 3.253；P=0.001）、年龄（HR 1.543，95%CI，1.063 - 2.239；P=0.025）和纵隔淋巴结转移（HR 2.655，95%CI，1.809 - 3.897；P<0.001）是OS的独立预后危险因素。
我们将PA确定为预测接受肺癌手术且有PA危险因素患者OS不良的独立预后危险因素。因此，我们为PA改善肺癌患者预后提供了指导。
