Dataset Information

Prognostic role of minute ventilation/carbon dioxide production slope for perioperative morbidity and long-term survival in resectable patients with non-small-cell lung cancer: A prospective study using propensity score overlap weighting.

ABSTRACT:

Background

The role of minute ventilation/carbon dioxide production (/CO2) slope, a ventilation efficiency marker, in predicting short- and long-term health outcomes for patients with non-small-cell lung cancer (NSCLC) undergoing lung resection has not been well investigated.

Material and methods

This prospective cohort study consecutively enrolled NSCLC patients who underwent a presurgical cardiopulmonary exercise test from November 2014 to December 2019. The association of /CO2 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/CO2 slope was estimated using the Receiver Operating Characteristics curve. Internal validation was completed through bootstrap resampling.

Results

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/CO2 slope, respectively (weighted incidence rate difference per 1000 person-years, 29.21 [95% CI, 7.30 to 51.12]). A E/CO2 slope of ≥31 was associated with shorter RFS (hazard ratio for relapse or death, 1.38 [95% CI, 1.02 to 1.88], P=0.04) and poorer OS (hazard ratio for death, 1.69 [1.15 to 2.48], P=0.02) compared to a lower /CO2 slope. A high E/CO2 slope increased the risk of perioperative morbidity compared with a low E/CO2 slope (odds ratio, 2.32 [1.54 to 3.49], P<0.001).

Conclusions

In patients with operable NSCLC, a high E/CO2 slope was significantly associated with elevated risks of poorer RFS and OS, and perioperative morbidity.

SUBMITTER: Dun Y

PROVIDER: S-EPMC10498874 | biostudies-literature | 2023 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Prognostic role of minute ventilation/carbon dioxide production slope for perioperative morbidity and long-term survival in resectable patients with nonsmall-cell lung cancer: a prospective study using propensity score overlap weighting.

Dun Yaoshan Y Wu Shaoping S Cui Ni N Thomas Randal J RJ Squires Ray W RW Olson Thomas P TP Sylvester Karl P KP Fu Siqian S Zhang Chunfang C Gao Yang Y Du Yang Y Xu Ning N Liu Suixin S Liu Suixin S

International journal of surgery (London, England) 20230901 9

<h4>Background</h4>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.<h4>Material and methods</h4>This prospective cohort study consecutively enrolled NSCLC patients who underwent a presurgical cardiopulmonary exercise test from November 2014 to December 2019. The association o ...[more]

PMID: 37204476

Similar Datasets

Project description:BackgroundPerioperative hemoglobin drop after noncardiac surgery is associated with acute kidney injury (AKI). However, opinion on the tolerable difference in postoperative hemoglobin drop in patients with different preoperative hemoglobin levels does not reach a consensus. This study aimed to identify hemoglobin drop thresholds for AKI after noncardiac surgery stratified by preoperative hemoglobin levels.MethodThis was a single-center retrospective cohort study for elective noncardiac surgery from January 1, 2012, to December 31, 2018. The endpoint was the occurrence of AKI 7 days postoperatively in the hospital. The generalized additive model described the non-linear relationship between hemoglobin drop and AKI occurrence. The minimum P-value approach identified cut-off points of hemoglobin drop within postoperative 7 days for patients with or without preoperative anemia. Stratified by preoperative anemia, hemoglobin drop's odds ratio as continuous, quintile and dichotomous variables by various cut-off points for postoperative AKI were calculated in multivariate logistic regression models before and after propensity score weighting (PSW).ResultsOf the 35,631 surgery, 5.9% (2105 cases) suffered postoperative AKI. Non-linearity was found between hemoglobin drop and postoperative AKI occurrence. The thresholds and corresponding odds ratio of perioperative hemoglobin drop for patients with and without preoperative anemia were 18 g/L (1.38 (95%CI 1.14 -1.62), P < .001; after PSW: 1.42 (95%CI 1.17 -1.74), P < .001) and 43 g/L (1.81 (95%CI 1.35-2.27), P < .001; after PSW: 2.88 (95%CI 1.85-4.50), P < .001) respectively. Overall thresholds and corresponding odds ratio were 43 g/L (1.82 (95%CI 1.42-2.21)), P < .001; after PSW: 3.29 (95%CI 2.00-5.40), P < .001). Sensitivity analysis showed similar results. Heterogeneity subgroup analysis showed that intraoperatively female patients undergoing intraperitoneal surgery without colloid infusion seemed to be more vulnerable to higher hemoglobin drop. Further analysis showed a possible linear relationship between preoperative hemoglobin and perioperative hemoglobin drop thresholds. Additionally, this study found that the creatinine level changed simultaneously with hemoglobin level within five postoperative days.ConclusionsHeterogeneity of hemoglobin drop endurability exists after noncardiac non-kidney surgery. More care and earlier intervention should be put on patients with preoperative anemia.

Project description:BackgroundNon-intubated thoracoscopic surgery with spontaneous breathing is rarely utilized, but may have several advantages over standard intubation, especially in those with significant cardiopulmonary comorbidities. In this study we evaluate the safety, feasibility, and 3-year survival of thoracoscopic surgery without endotracheal intubation for oncologic and non-oncologic indications.MethodsAll consecutive patients [2018-2022] selected for lung resection or other pleural space intervention under local anesthesia and sedation were compared to a cohort undergoing elective thoracoscopic procedures with endotracheal intubation. A propensity-score matched cohort was used to compare perioperative outcomes and 3-year overall survival.ResultsA total of 72 patients underwent thoracoscopic surgery without intubation compared to 1,741 who were intubated. Non-intubated procedures included 19 lobectomies (26.4%), 9 segmentectomies (12.5%), 25 wedge resections (34.7%), and 19 pleural or mediastinal resections (26.4%). Non-intubated patients had a lower average body mass index (BMI; 24.6 vs. 27.1 kg/m2, P<0.001) and a higher comorbidity burden. Primary lung cancer was the indication in 30 (41.7%) non-intubated patients. The non-intubated cohort had no operative or 30-day mortality. After propensity-score matching, there was no significant difference in pre-operative factors. In propensity-score matched analysis, non-intubated patients had shorter median total operating room time (109 vs. 159 min, P<0.001) and procedure time (69 vs. 119 min, P<0.001). Peri-operative morbidity was rare and did not differ between intubated and non-intubated patients. There was no significant difference in 3-year survival associated with non-intubation in the propensity-score matched cohorts (95% vs. 89%, P=0.10) or in a Cox proportional hazard model [hazard ratio (HR), 1.15; 95% confidence interval (CI): 0.36-3.67; P=0.81].ConclusionsNon-intubated thoracoscopic surgery is safe and feasible in carefully selected patients for both benign and oncologic indications.

Project description:BackgroundVentilatory inefficiency contributes to exercise intolerance in chronic obstructive pulmonary disease (COPD). The intercept of the minute ventilation (V˙ E) vs. carbon dioxide output (V˙ CO2) plot is a key ventilatory inefficiency parameter. However, its relationships with lung hyperinflation (LH) and airflow limitation are not known. This study aimed to evaluate correlations between the V˙ E/V˙ CO2 intercept and LH and airflow limitation to determine its physiological interpretation as an index of functional impairment in COPD.MethodsWe conducted a retrospective analysis of data from 53 COPD patients and 14 healthy controls who performed incremental cardiopulmonary exercise tests (CPETs) and resting pulmonary function assessment. Ventilatory inefficiency was represented by parameters reflecting the V˙ E/V˙ CO2 nadir and slope (linear region) and the intercept of V˙ E/V˙ CO2 plot. Their correlations with measures of LH and airflow limitation were evaluated.ResultsCompared to control, the slope (30.58±3.62, P<0.001) and intercept (4.85±1.11 L/min, P<0.05) were higher in COPDstages1-2, leading to a higher nadir (31.47±4.47, P<0.01). Despite an even higher intercept in COPDstages3-4 (7.16±1.41, P<0.001), the slope diminished with disease progression (from 30.58±3.62 in COPDstages1-2 to 26.84±4.96 in COPDstages3-4, P<0.01). There was no difference in nadir among COPD groups and higher intercepts across all stages. The intercept was correlated with peak V˙ E/maximal voluntary ventilation (MVV) (r=0.489, P<0.001) and peak V˙ O2/Watt (r=0.354, P=0.003). The intercept was positively correlated with residual volume (RV) % predicted (r=0.571, P<0.001), RV/total lung capacity (TLC) (r=0.588, P<0.001), peak tidal volume (VT)/FEV1 (r=0.482, P<0.001) and negatively correlated with rest inspiratory capacity (IC)/TLC (r=-0.574, P<0.001), peak VT/TLC (r=-0.585, P<0.001), airflow limitation forced expiratory volume in 1 s (FEV1) % predicted (r=-0.606, P<0.001), and FEV1/forced vital capacity (FVC) (r=-0.629, P<0.001).ConclusionsV˙ E/V˙ CO2 intercept was consistently correlated with worsening static and dynamic LH, pulmonary gas exchange, and airflow limitation in COPD. The V˙ E/V˙ CO2 intercept emerged as a useful index of ventilatory inefficiency in COPD patients.