Hong Seung-Wan, Lee Song-Am, Kim Seong-Hyop
Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
Department of Thoracic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
J Thorac Dis. 2023 Mar 31;15(3):1063-1074. doi: 10.21037/jtd-22-1156. Epub 2023 Mar 6.
This retrospective study was designed to evaluate preoperative pulmonary function test (PFT) results and skeletal muscle mass, represented by the erector spinae muscle (EM), as predictors of postoperative pulmonary complications (PPCs) in older patients undergoing lobectomy for lung cancer.
The medical records, including preoperative PFT, chest computed tomography (CT) and PPCs, of patients older than 65 years undergoing lobectomy for lung cancer were retrospectively examined at Konkuk University Medical Center from January 2016 to December 2021. The sum of cross-sectional areas (CSAs) of the right and left EMs at the level of the spinous process with the 12 thoracic vertebra was used as the skeletal muscle mass (CSA).
Data from a total of 197 patients were included in the analyses. In total, 55 patients had PPCs. The preoperative functional vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) showed significantly poorer values and the CSA had significantly lower values in patients with than in those without PPCs. The preoperative FVC and FEV1 showed significant positive correlations with CSA. Multiple logistic regression analysis identified age, diabetes mellitus (DM), preoperative FVC and CSA as risk factors for PPCs. The areas under the curves for FVC and CSA were 0.727 (95% CI, 0.650-0.803; P<0.001) and 0.685 (95% CI, 0.608-0.762; P<0.001), respectively. The optimal threshold values of FVC and CSA to predict PPCs based on a receiver operating characteristic curve analysis were 2.685 L (sensitivity =64.1% and specificity =61.8%) and 28.47 mm (sensitivity =62.0% and specificity =61.5%), respectively.
PPCs in older patients undergoing lobectomy for lung cancer were associated with lower preoperative FVC and FEV1 values and a lower skeletal muscle mass. Skeletal muscle mass, represented by the EM, was significantly correlated with the preoperative FVC and FEV1. Therefore, skeletal muscle mass may be useful for the prediction of PPCs in patients undergoing lobectomy for lung cancer.
本回顾性研究旨在评估术前肺功能测试（PFT）结果以及以竖脊肌（EM）表示的骨骼肌质量，作为老年肺癌患者肺叶切除术后肺部并发症（PPC）的预测指标。
回顾性分析2016年1月至2021年12月在建国大学医学中心接受肺癌肺叶切除术的65岁以上患者的病历，包括术前PFT、胸部计算机断层扫描（CT）和PPC。以第12胸椎棘突水平的左右EM横截面积（CSA）之和作为骨骼肌质量（CSA）。
共197例患者的数据纳入分析。总计55例患者发生PPC。术前功能肺活量（FVC）和第1秒用力呼气量（FEV1）在发生PPC的患者中显著低于未发生PPC的患者，且CSA也显著更低。术前FVC和FEV1与CSA呈显著正相关。多因素逻辑回归分析确定年龄、糖尿病（DM）、术前FVC和CSA为PPC的危险因素。FVC和CSA的曲线下面积分别为0.727（95%CI，0.650 - 0.803；P<0.001）和0.685（95%CI，0.608 - 0.762；P<0.001）。基于受试者工作特征曲线分析预测PPC的FVC和CSA的最佳阈值分别为2.685L（敏感性 = 64.1%，特异性 = 61.8%）和28.47mm（敏感性 = 62.0%，特异性 = 61.5%）。
老年肺癌患者肺叶切除术后的PPC与术前较低的FVC和FEV1值以及较低的骨骼肌质量相关。以EM表示的骨骼肌质量与术前FVC和FEV1显著相关。因此，骨骼肌质量可能有助于预测肺癌肺叶切除患者的PPC。
