Preoperative serum fibrinogen level predicts postoperative pulmonary complications after lung cancer resection.
BACKGROUND
Patients undergoing pulmonary resection are thought to be at high risk for the development of postoperative pulmonary complications (PPCs), and these complications may lead to serious morbidity. The purpose of this study was to identify the factors associated with postoperative pulmonary complications in patients undergoing lung cancer resection and to determine the effect of PPCs on survival.


METHODS
The study involved a retrospective review of 635 patients who had undergone curative resection for lung cancer. The patient group included 504 males (79.4%), and the overall mean age was 61.3 years. Patients were classified as those who had experienced PPCs (PPCs group, n = 105, 16.5%) or those who had not (no-PPCs group, n = 530, 83.5%).


RESULTS
The surgical procedures performed were 101 pneumonectomies (15.9%), 505 lobectomies (79.5%), and 29 lesser resections (4.6%). Cancer types comprised 330 squamous cell carcinomas (52.0%), 255 adenocarcinomas (40.2%) and 50 others (7.8%). Univariate analysis showed that the following factors were predictors for PPCs: male sex, erythrocyte sedimentation rate, preoperative serum fibrinogen level, pulmonary function, chronic obstructive pulmonary disease, smoking, double primary cancer, and surgical duration. Multivariate logistic regression showed that preoperative serum fibrinogen level (p < 0.001), surgical duration (p < 0.0001) and being male (p = 0.02) were significant predictors of PPCs. Overall survival 3 years after surgery was 68.2% in no-PPCs group and 38.8% in PPCs group (p < 0.0001). Regardless of tumor staging, overall survival differed significantly between PPCs and no-PPCs groups, whereas disease-free survival did not.


CONCLUSIONS
Higher preoperative serum fibrinogen levels, longer surgical duration, and being male were the predictive factors for PPCs in surgical candidates. The development of PPCs was linked to a shortened overall survival.
Song
Suk-Won
SW
Cancer Biostatistics Branch, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea.
Lee
Hyun-Sung
HS
Kim
Moon Soo
MS
Lee
Jong Mog
JM
Kim
Jee Hee
JH
Nam
Byung-Ho
BH
Zo
Jae Ill
JI
D000230:Adenocarcinoma / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001983:Bronchial Fistula / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D001986:Bronchial Spasm / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D018287:Carcinoma, Large Cell / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D016724:Empyema, Pleural / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005340:Fibrinogen / Q000032:analysis*; D005402:Fistula / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007432:Intraoperative Period; D015993:Life Tables; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000097:blood / Q000453:epidemiology / Q000209:etiology; D011013:Pneumonectomy / Q000379:methods / Q000706:statistics & numerical data; D011014:Pneumonia / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000097:blood* / Q000453:epidemiology; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012128:Respiratory Distress Syndrome / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012306:Risk; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D013183:Sputum; D016019:Survival Analysis; D015996:Survival Rate
D005340:Fibrinogen