Dun Yaoshan, Wu Shaoping, Cui Ni, Thomas Randal J, Squires Ray W, Olson Thomas P, Sylvester Karl P, Fu Siqian, Zhang Chunfang, Gao Yang, Du Yang, Xu Ning, Liu Suixin
Department of Physical Medicine and Rehabilitation, Division of Cardiac Rehabilitation.
National Clinical Research Center for Geriatric Disorders.
Int J Surg. 2023 Sep 1;109(9):2650-2659. doi: 10.1097/JS9.0000000000000509.
The role of minute ventilation/carbon dioxide production ( / CO 2 ) slope, a ventilation efficiency marker, in predicting short-term and long-term health outcomes for patients with nonsmall-cell lung cancer (NSCLC) undergoing lung resection has not been well investigated.
This prospective cohort study consecutively enrolled NSCLC patients who underwent a presurgical cardiopulmonary exercise test from November 2014 to December 2019. The association of / CO 2 slope with relapse-free survival (RFS), overall survival (OS), and perioperative mortality was evaluated using the Cox proportional hazards and logistic models. Covariates were adjusted using propensity score overlap weighting. The optimal cut-off point of the E/ CO 2 slope was estimated using the receiver operating characteristics curve. Internal validation was completed through bootstrap resampling.
A cohort of 895 patients [median age (interquartile range), 59 (13) years; 62.5% male] was followed for a median of 40 (range, 1-85) months. Throughout the study, there were 247 relapses or deaths and 156 perioperative complications. The incidence rates per 1000 person-years for relapses or deaths were 108.8 and 79.6 among patients with high and low E/ CO 2 slopes, respectively [weighted incidence rate difference per 1000 person-years, 29.21 (95% CI, 7.30-51.12)]. A E/ CO 2 slope of greater than or equal to 31 was associated with shorter RFS [hazard ratio for relapse or death, 1.38 (95% CI, 1.02-1.88), P =0.04] and poorer OS [hazard ratio for death, 1.69 (1.15-2.48), P =0.02] compared to a lower / CO 2 slope. A high E/ CO 2 slope increased the risk of perioperative morbidity compared with a low E/ CO 2 slope [odds ratio, 2.32 (1.54-3.49), P <0.001].
In patients with operable NSCLC, a high E/ CO 2 slope was significantly associated with elevated risks of poorer RFS, OS, and perioperative morbidity.
分钟通气量/二氧化碳产生量（ /CO₂）斜率作为一种通气效率指标，在预测接受肺切除术的非小细胞肺癌（NSCLC）患者的短期和长期健康结局方面尚未得到充分研究。
这项前瞻性队列研究连续纳入了2014年11月至2019年12月期间接受术前心肺运动试验的NSCLC患者。使用Cox比例风险模型和逻辑模型评估 /CO₂斜率与无复发生存期（RFS）、总生存期（OS）和围手术期死亡率之间的关联。使用倾向得分重叠加权法对协变量进行调整。使用受试者工作特征曲线估计 /CO₂斜率的最佳截断点。通过自助重采样完成内部验证。
对895例患者进行了中位时间为40（范围1 - 85）个月的随访，患者的中位年龄（四分位间距）为59（13）岁，男性占62.5%。在整个研究过程中，有247例复发或死亡，156例围手术期并发症。 /CO₂斜率高和低的患者每1000人年的复发或死亡率分别为108.8和79.6[每1000人年的加权发病率差异为29.21（95%CI，7.30 - 51.12）]。与较低的 /CO₂斜率相比， /CO₂斜率大于或等于31与较短的RFS[复发或死亡风险比，1.38（95%CI，1.02 - 1.88），P = 0.04]和较差的OS[死亡风险比，1.69（1.15 - 2.48），P = 0.02]相关。与低 /CO₂斜率相比，高 /CO₂斜率增加了围手术期发病风险[比值比，2.32（1.54 - 3.49），P < 0.001]。
在可手术切除的NSCLC患者中，高 /CO₂斜率与较差的RFS、OS及围手术期发病风险升高显著相关。
