Cardiopulmonary co-morbidity: a critical negative prognostic predictor for pulmonary resection following preoperative chemotherapy and/or radiation therapy in lung cancer patients.
OBJECTIVE
Preoperative therapy is an optional strategy for locally advanced lung cancer, although the indication for pulmonary resection is often marginal, when considering the survival benefit and perioperative risks. The aim of the present study was to identify prognostic predictors by assessing clinical factors including pre-thoracotomy co-morbidity.


METHODS
This was a retrospective analysis of 54 patients who underwent complete resection after preoperative therapy was performed.


RESULTS
The overall 5-year survival rate was 38%. In patients without cardiopulmonary co-morbidity the 5-year survival rate was 49%, whereas it was 0% for those who had associated cardiopulmonary co-morbidity (P = 0.004). When analyzing only those who died from lung cancer, the group without cardiopulmonary comorbidity showed a tendency for longer survival than those in the co-morbidity group (P = 0.092). The 5-year survival rate for patients--evaluated with a Charlson Co-morbidity Index (CCI)--with a CCI score of 0, was 45%, which tended to be better than that for those with a CCI score of 1-2 (P = 0.066). Furthermore, patients with a normal prethoracotomy level of carcinoembryonic antigen (CEA) had a 5-year survival rate of 44%, which was better than the 22% for patients with elevated CEA (P = 0.013). The 5-year survival rate for patients without lymph node metastasis was 52%, whereas it was 14% for those with residual node involvement (P = 0.002). Lymph node metastasis and cardiopulmonary co-morbidity were shown to be independent poor prognostic predictors by multivariate analysis.


CONCLUSIONS
In addition to nodal status, preoperative cardiopulmonary co-morbidity should be noted when considering the operative indications following preoperative therapy for lung cancer patients.
Inoue
Masayoshi
M
Department of Surgery, Division of Thoracic and Cardiovascular Surgery, Osaka University Graduate School of Medicine, E1-2-2 Yamadaoka, Suita, Osaka 565-0871, Japan masa@surg1.med.osaka-u.ac.jp
Okumura
Meinoshin
M
Minami
Masato
M
Shiono
Hiroyuki
H
Sawabata
Noriyoshi
N
Utsumi
Tomoki
T
Ohno
Yuko
Y
Sawa
Yoshiki
Y
D000328:Adult; D000368:Aged; D002272:Carcinoembryonic Antigen / Q000097:blood; D003131:Combined Modality Therapy; D005260:Female; D006331:Heart Diseases / Q000150:complications*; D006801:Humans; D008171:Lung Diseases / Q000150:complications*; D008175:Lung Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
D002272:Carcinoembryonic Antigen