Hong Zhi-Nuan, Weng Kai, Chen Zhen, Peng Kaiming, Kang Mingqiang
Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, China.
Front Surg. 2022 May 12;9:794553. doi: 10.3389/fsurg.2022.794553. eCollection 2022.
This study aimed to investigate whether the difference between "lung age" and real age (L-R) could be useful for the prediction of postoperative complications and long-term survival in patients with esophageal cancer followed by minimally invasive esophagectomy (MIE).
This retrospective cohort study included 625 consecutive patients who had undergone MIE. "Lung age" was determined by the calculation method proposed by the Japanese Respiratory Society. According to L-R, patients were classified into three groups: group A: L-R ≦ 0 (= 104), group B: 15 > L-R > 0 (= 199), group C: L-R ≥ 15 ( = 322). Clinicopathological factors, postoperative complications evaluated by comprehensive complications index (CCI), and overall survival were compared between the groups. A CCI value >30 indicated a severe postoperative complication.
Male, smoking status, smoking index, chronic obstructive pulmonary disease, American Society of Anesthesiologists status, lung age, and forced expiratory volume in 1 s were associated with group classification. CCI values, postoperative hospital stays, and hospital costs were significantly different among groups. Multivariate analysis indicated that L-R, coronary heart disease, and 3-field lymphadenectomy were significant factors for predicting CCI value >30. Regarding the prediction of CCI value >30, area under the curve value was 0.61(95%: 0.56-0.67), 0.46 (95% CI, 0.40-0.54), and 0.46 (95% CI, 0.40-0.54) for L-R, Fev1, and Fev1%, respectively. Regarding overall survival, there was a significant difference between group A and group B + C (log-rank test: = 0.03).
Esophageal cancer patients with impaired pulmonary function had a higher risk of severe postoperative complications and poorer prognosis than those with normal pulmonary function. The difference between "lung age" and "real age" seems to be a novel and potential predictor of severe postoperative complications and long-term survival.
本研究旨在探讨“肺龄”与实际年龄之差（L-R）是否有助于预测接受微创食管切除术（MIE）的食管癌患者的术后并发症及长期生存情况。
这项回顾性队列研究纳入了625例连续接受MIE的患者。“肺龄”采用日本呼吸学会提出的计算方法确定。根据L-R，患者被分为三组：A组：L-R≤0（=104例），B组：15＞L-R＞0（=199例），C组：L-R≥15（=322例）。比较三组之间的临床病理因素、采用综合并发症指数（CCI）评估的术后并发症以及总生存期。CCI值＞30表明术后存在严重并发症。
男性、吸烟状况、吸烟指数、慢性阻塞性肺疾病、美国麻醉医师协会分级、肺龄以及第1秒用力呼气量与分组相关。三组之间的CCI值、术后住院时间及住院费用存在显著差异。多因素分析表明，L-R、冠心病和三野淋巴结清扫是预测CCI值＞30的显著因素。关于CCI值＞30的预测，L-R、第1秒用力呼气量（Fev1）和第1秒用力呼气量占预计值百分比（Fev1%）的曲线下面积值分别为0.61（95%：0.56-0.67）、0.46（95%CI，0.40-0.54）和0.46（95%CI，0.40-0.54）。关于总生存期，A组与B组+C组之间存在显著差异（对数秩检验：P=0.03）。
肺功能受损的食管癌患者比肺功能正常的患者术后发生严重并发症的风险更高，预后更差。“肺龄”与“实际年龄”之差似乎是术后严重并发症及长期生存的一种新的潜在预测指标。
