心肺运动变量及其与主要食管胃癌手术后术后发病率和死亡率的关联——一项多中心观察性研究

Cardiopulmonary exercise variables and their association with postoperative morbidity and mortality after major oesophagogastric cancer surgery-a multicentre observational study.

作者信息

West Malcolm A, Rahman Saqib, Jack Sandy, Grocott Michael P W, Levett Denny Z H, Rashid Yasir, Griffiths John, Ezra Martin, Ayres Lyndsay, Neville-Webbe Helen, Javed Muhammad Shafiq, Shrotri Milind, Khan Iftikhar, Whitmore David, Prabhu Pradeep, Timbrell David, Allen Sophie, Packham Andrew O, Sharpe David, Anderson Helen, Minto Gary, McAleer Samuel, McPhail Stuart, Alasmar Mohamed, Hartley Robert A, Sultan Javed, Grace Ben, Underwood Timothy J, Byrne James, Noble Fergus, Kelly Jamie, Ansell Gillian, Edwards Mark

机构信息

School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.

Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK.

出版信息

BJA Open. 2024 Jun 7;10:100289. doi: 10.1016/j.bjao.2024.100289. eCollection 2024 Jun.

DOI:10.1016/j.bjao.2024.100289

PMID:38947220

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11214286/

Abstract

BACKGROUND

Outcomes after oesophagogastric cancer surgery remain poor. Cardiopulmonary exercise testing (CPET) used for risk stratification before oesophagogastric cancer surgery is based on conflicting evidence. This study explores the relationship between CPET and postoperative outcomes, specifically for patients undergoing neoadjuvant treatment.

METHODS

Patients undergoing oesophagogastric cancer resection and CPET (pre- or post-neoadjuvant treatment, or both) were retrospectively enrolled into a multicentre pooled cohort study. Oxygen uptake at peak exercise (VO peak) was compared with 1-yr postoperative survival. Secondary analyses explored relationships between patient characteristics, tumour pathology characteristics, CPET variables (absolute, relative to weight, ideal body weight, and body surface area), and postoperative outcomes (morbidity, 1-yr and 3-yr survival) were assessed using logistic regression analyses.

RESULTS

Seven UK centres recruited 611 patients completing a 3-yr postoperative follow-up period. Oesophagectomy was undertaken in 475 patients (78%). Major complications occurred in 25%, with 18% 1-yr and 43% 3-yr mortality. No association between VO peak or other selected CPET variables and 1-yr survival was observed in the overall cohort. In the overall cohort, the anaerobic threshold relative to ideal body weight was associated with 3-yr survival (=0.013). Tumour characteristics (ypT/ypN/tumour regression/lymphovascular invasion/resection margin; <0.001) and Clavien-Dindo ≥3a (<0.001) were associated with 1-yr and 3-yr survival. On subgroup analyses, pre-neoadjuvant treatment CPET; anaerobic threshold (absolute; =0.024, relative to ideal body weight; =0.001, body surface area; =0.009) and V/VCO at anaerobic threshold (=0.026) were associated with 3-yr survival. No other CPET variables (pre- or post-neoadjuvant treatment) were associated with survival.

CONCLUSIONS

VO peak was not associated with 1-yr survival after oesophagogastric cancer resection. Tumour characteristics and major complications were associated with survival; however, only some selected pre-neoadjuvant treatment CPET variables were associated with 3-yr survival. CPET in this cohort of patients demonstrates limited outcome predictive precision.

CLINICAL TRIAL REGISTRATION

NCT03637647.

摘要

背景

食管癌和胃癌手术后的预后仍然很差。用于食管癌和胃癌手术前风险分层的心肺运动试验（CPET）所依据的证据相互矛盾。本研究探讨了CPET与术后预后之间的关系，特别是对于接受新辅助治疗的患者。

方法

对接受食管癌和胃癌切除术及CPET（新辅助治疗前、后或两者均有）的患者进行回顾性纳入一项多中心汇总队列研究。将峰值运动时的摄氧量（VO₂峰值）与术后1年生存率进行比较。次要分析探讨了患者特征、肿瘤病理特征、CPET变量（绝对值、相对于体重、理想体重和体表面积）与术后预后（发病率、1年和3年生存率）之间的关系，采用逻辑回归分析进行评估。

结果

7个英国中心招募了611例患者，完成了3年的术后随访期。475例患者（78%）接受了食管切除术。25%发生了主要并发症，1年死亡率为18%，3年死亡率为43%。在整个队列中，未观察到VO₂峰值或其他选定的CPET变量与1年生存率之间存在关联。在整个队列中，相对于理想体重的无氧阈值与3年生存率相关（P=0.013）。肿瘤特征（ypT/ypN/肿瘤退缩/脉管侵犯/切缘；P<0.001）和Clavien-Dindo≥3a级（P<0.001）与1年和3年生存率相关。在亚组分析中，新辅助治疗前的CPET；无氧阈值（绝对值；P=0.024，相对于理想体重；P=0.001，体表面积；P=0.009）和无氧阈值时的Vₑ/VCO₂（P=0.026）与3年生存率相关。没有其他CPET变量（新辅助治疗前或后）与生存率相关。