Department of Cardiothoracic Surgery, University Hospital of Cologne, Kerpenerstrasse 62, 50937, Cologne, Germany.
Clinic for Pneumology and Allergology, Hospital Bethanien, Aufderhöher Strasse. 169-175, 42699, Solingen, Germany.
Lung. 2021 Aug;199(4):395-402. doi: 10.1007/s00408-021-00464-4. Epub 2021 Aug 13.
Preoperative pulmonary function testing is mandatory for non-small cell lung cancer (NSCLC) surgery. The predicted postoperative FEV1 (ppoFEV1) is used for further risk stratification. We compared the ppoFEV1 with the postoperative FEV1 (postFEV1) in order to improve the calculation of the ppoFEV1.
87 patients voluntarily received an FEV1 assessment 1 year after surgery. ppoFEV1 was calculated according to the Brunelli calculation. Baseline characteristics and surgical procedure were compared in a uni- and multivariate analysis between different accuracy levels of the ppoFEV1. Parameters which remained significant in the multinominal regression analysis were evaluated for a modification of the ppoFEV1 calculation.
Independent factors for a more inaccurate ppoFEV1 were preoperative active smoking (odds ratio (OR) 4.1, confidence interval (CI) 3.6-6.41; p = 0.01), packyears (OR 4.1, CI 3.6-6.41; p = 0.008), younger age (OR 1.1, CI 1.01-1.12; p = 0.03), and patients undergoing pneumectomy (OR 5.55, CI 1.35-23.6; p = 0.01). For the customized ppoFEV1 we excluded pneumonectomies. For patients < 60 years, an additional lung segment was added to the calculation. ppoFEV1 = preFEV1 × [Formula: see text]. For actively smoking patients with more than 30 packyears we subtracted one lung segment from the calculation ppoFEV1 = PreFEV1 × [Formula: see text].
We were able to enhance the predictability of the ppoFEV1 with modifications. The modified ppoFEV1 (1.828 l ± 0.479 l) closely approximates the postFEV1 of 1.823 l ± 0.476 l, (0.27%) while the original ppoFEV1 calculation is at 1.78 l ± 0.53 (2.19%). However, if patients require pneumectomy, more complex techniques to determine the ppoFEV1 should be included to stratify risk.
非小细胞肺癌（NSCLC）手术前必须进行肺功能检查。预测术后 FEV1（ppoFEV1）用于进一步的风险分层。我们比较了 ppoFEV1 和术后 FEV1（postFEV1），以便改进 ppoFEV1 的计算。
87 例患者自愿在术后 1 年接受 FEV1 评估。ppoFEV1 根据 Brunelli 计算得出。在单变量和多变量分析中，比较了不同 ppoFEV1 准确性水平之间的基本特征和手术程序。在多项回归分析中保留的显著参数被评估用于 ppoFEV1 计算的修正。
ppoFEV1 更不准确的独立因素是术前主动吸烟（优势比（OR）4.1，置信区间（CI）3.6-6.41；p=0.01）、吸烟年限（OR 4.1，CI 3.6-6.41；p=0.008）、年龄较小（OR 1.1，CI 1.01-1.12；p=0.03）和行肺切除术（OR 5.55，CI 1.35-23.6；p=0.01）。对于定制的 ppoFEV1，我们排除了肺切除术。对于年龄<60 岁的患者，在计算中增加一个肺段。ppoFEV1=preFEV1×[公式：见正文]。对于吸烟超过 30 包年的主动吸烟者，从计算中减去一个肺段 ppoFEV1=PreFEV1×[公式：见正文]。
我们能够通过修正来提高 ppoFEV1 的可预测性。修正后的 ppoFEV1（1.828 l±0.479 l）与 1.823 l±0.476 l（0.27%）的 postFEV1 非常接近，而原始 ppoFEV1 计算为 1.78 l±0.53（2.19%）。但是，如果患者需要行肺切除术，则应包括更复杂的技术来确定 ppoFEV1，以进行风险分层。
Zotero 插件
