心肺运动试验中分钟通气量与二氧化碳斜率增加与肺癌切除术后不良术后结局相关。

Increased minute ventilation-to-carbon dioxide slope during cardiopulmonary exercise test is associated with poor postoperative outcome following lung cancer resection.

机构信息

Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK.

出版信息

Eur J Cardiothorac Surg. 2024 Mar 1;65(3). doi: 10.1093/ejcts/ezad337.

DOI:10.1093/ejcts/ezad337

PMID:37812232

Abstract

OBJECTIVES

Ventilatory efficiency [minute ventilation-to-carbon dioxide output slope (VE/VCO2 slope)] can be measured at sub-maximal workload during cardiopulmonary exercise test. The aim of this study is to assess the association between VE/VCO2 slope and outcome after lung cancer resections.

METHODS

Retrospective, single-centre analysis on all patients undergoing lung resection for cancer (April 2014-August 2022) and with a preoperative cardiopulmonary exercise test. VE/VCO2 slope >40 was chosen as high-risk threshold. Logistic regression analysis was used to test the association of VE/VCO2 slope and several patient- and surgery-related factors with 90-day mortality.

RESULTS

A total of 552 patients were included (374 lobectomies, 81 segmentectomies, 55 pneumonectomies and 42 wedge resections). Seventy-four percent were minimally invasive procedures. Cardiopulmonary morbidity was 32%, in-hospital/30-day mortality 6.9% and 90-day mortality 8.9%. A total of 137 patients (25%) had a slope of >40. These patients were older (72 vs 70 years, P = 0.012), had more frequently coronary artery disease (17% vs 10%, P = 0.028), lower carbon monoxide lung diffusion capacity (57% vs 68%, P < 0.001), lower body mass index (25.4 vs 27.0 kg/m2, P = 0.001) and lower peak VO2 (14.9 vs 17.0 ml/kg/min, P < 0.001) than those with a lower slope. The cardiopulmonary morbidity among patients with a slope of >40 was 40% vs 29% in those with lower slope (P = 0.019). Ninety-day mortality was 15% vs 6.7% (P = 0.002). The 90-day mortality of elderly patients with slope >40 was 21% vs 7.8% (P = 0.001). After adjusting for peak VO2 value, extent of operation and other patient-related variables in a logistic regression analysis, VE/VCO2 slope retained a significant association with 90-day mortality.

CONCLUSIONS

VE/VCO2 slope was strongly associated with morbidity and mortality following lung resection and should be included in the functional algorithm to assess fitness for surgery.

摘要

目的

在心肺运动试验中，可以在亚最大工作负荷下测量通气效率[分钟通气量与二氧化碳输出斜率（VE/VCO2 斜率）]。本研究的目的是评估 VE/VCO2 斜率与肺癌切除术后结局的关系。

方法

回顾性分析 2014 年 4 月至 2022 年 8 月期间所有接受肺癌切除术（肺叶切除术 374 例，肺段切除术 81 例，全肺切除术 55 例，楔形切除术 42 例）并进行术前心肺运动试验的患者。选择 VE/VCO2 斜率>40 作为高危阈值。使用逻辑回归分析来测试 VE/VCO2 斜率与几个与患者和手术相关的因素与 90 天死亡率之间的关联。

结果

共纳入 552 例患者（肺叶切除术 74%为微创手术）。552 例患者中，74%为微创手术。心肺发病率为 32%，住院/30 天死亡率为 6.9%，90 天死亡率为 8.9%。共有 137 例（25%）患者的斜率>40。这些患者年龄更大（72 岁与 70 岁，P=0.012），更常患有冠状动脉疾病（17%与 10%，P=0.028），一氧化碳肺扩散能力更低（57%与 68%，P<0.001），体重指数更低（25.4 与 27.0kg/m2，P=0.001），峰值 VO2 更低（14.9 与 17.0ml/kg/min，P<0.001）。VE/VCO2 斜率>40 的患者的心肺发病率为 40%，而斜率<40 的患者为 29%（P=0.019）。90 天死亡率为 15%与 6.7%（P=0.002）。VE/VCO2 斜率>40 的老年患者 90 天死亡率为 21%，而斜率<40 的老年患者为 7.8%（P=0.001）。在逻辑回归分析中，调整峰值 VO2 值、手术范围和其他与患者相关的变量后，VE/VCO2 斜率与 90 天死亡率仍有显著相关性。