Original article
General thoracic
Impact of Pulmonary Function Measurements on Long-Term Survival After Lobectomy for Stage I Non-Small Cell Lung Cancer

https://doi.org/10.1016/j.athoracsur.2015.02.076Get rights and content

Background

Pulmonary function tests predict respiratory complications after lobectomy. We evaluated the impact of pulmonary function measurements on long-term survival after lobectomy for stage I non-small cell lung cancer.

Methods

The relationship between percent predicted forced expiratory volume in 1 second (FEV1) and percent predicted diffusing capacity of the lung for carbon monoxide (Dlco) and overall survival for patients who underwent lobectomy without induction therapy for stage I (T1–2N0M0) non-small cell lung cancer from 1996 to 2012 was evaluated using the Kaplan-Meier approach and a multivariable Cox proportional hazard model.

Results

During the study period, 972 patients (mean Dlco 76 ± 21, mean FEV1 73 ± 21) met inclusion criteria. Perioperative mortality was 2.6% (n = 25). The 5-year survival of the entire cohort was 60.1%, with a median follow-up of 43 months. The 5-year survival for patients with percent predicted FEV1 stratified by more than 80%, 61% to 80%, 41% to 60%, and 40% or less was 70.1%, 59.3%, 52.5%, and 53.4%, respectively. The 5-year survival for patients with percent predicted Dlco stratified by more than 80%, 61% to 80%, 41% to 60%, and 40% or less was 70.2%, 63.4%, 44.2%, and 33.1%, respectively. In multivariable survival analysis, both larger tumor size (hazard ratio 1.15, p = 0.01) and lower Dlco (hazard ratio 0.986, p < 0.0001) were significant predictors of worse survival. The association of FEV1 and survival was not statistically significant (p = 0.18).

Conclusions

Survival after lobectomy for patients with stage I non-small cell lung cancer is impacted by lower Dlco, which can be used in the risk and benefit assessment when choosing therapy.

Section snippets

Patients and Methods

After obtaining Institutional Review Board approval, all patients who underwent lobectomy for NSCLC at Duke University Medical Center between the years 1996 and 2012 were reviewed. Only patients who underwent standard or sleeve lobectomy without previous chemotherapy or radiation for stage I (T1-2N0M0) NSCLC were included; patients who had bilobectomy were excluded. Stage was recorded based on the American Joint Committee on Cancer, seventh edition, staging system; patients treated during times

Results

Lobectomy was performed for stage I NSCLC in 972 patients who met all study criteria during the study period. Demographics, baseline characteristics, and comorbid conditions are shown in Table 1. The mean percent predicted Dlco for the cohort was 76% ± 21%, and the mean percent predicted FEV1 was 73% ± 21%. A minority of patients had either percent predicted Dlco or percent predicted FEV1 greater than 80% before surgery (28% of patients for each). There were 305 patients (31%) who had either

Comment

The results of this study quantify the impact of lower PFTs on survival after lobectomy for stage I NSCLC. Long-term overall survival when patients had either percent predicted Dlco or FEV1 greater than 80% was significantly better than when those values were less than 80%. However, decreasing values of FEV1 and Dlco had different associations with survival. The survival of patients with percent predicted FEV1 less than 80% was worse than that of patients with higher FEV1, although the

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