Integrating health status and survival data: the palliative effect of lung volume reduction surgery.
BACKGROUND
In studies that address health-related quality of life (QoL) and survival, subjects who die are usually censored from QoL assessments. This practice tends to inflate the apparent benefits of interventions with a high risk of mortality. Assessing a composite QoL-death outcome is a potential solution to this problem.


OBJECTIVE
To determine the effect of lung volume reduction surgery (LVRS) on a composite endpoint consisting of the occurrence of death or a clinically meaningful decline in QoL defined as an increase of at least eight points in the St. George's Respiratory Questionnaire total score from the National Emphysema Treatment Trial.


METHODS
In patients with chronic obstructive pulmonary disease and emphysema randomized to receive medical treatment (n = 610) or LVRS (n = 608), we analyzed the survival to the composite endpoint, the hazard functions and constructed prediction models of the slope of QoL decline.


RESULTS
The time to the composite endpoint was longer in the LVRS group (2 years) than the medical treatment group (1 year) (P < 0.0001). It was even longer in the subsets of patients undergoing LVRS without a high risk for perioperative death and with upper-lobe-predominant emphysema. The hazard for the composite event significantly favored the LVRS group, although it was most significant in patients with predominantly upper-lobe emphysema. The beneficial impact of LVRS on QoL decline was most significant during the 2 years after LVRS.


CONCLUSIONS
LVRS has a significant effect on the composite QoL-survival endpoint tested, indicating its meaningful palliative role, particularly in patients with upper-lobe-predominant emphysema.
Benzo
Roberto
R
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota 55902, USA. benzo.roberto@mayo.edu
Farrell
Max H
MH
Chang
Chung-Chou H
CC
Martinez
Fernando J
FJ
Kaplan
Robert
R
Reilly
John
J
Criner
Gerard
G
Wise
Robert
R
Make
Barry
B
Luketich
James
J
Fishman
Alfred P
AP
Sciurba
Frank C
FC
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000379:methods*; D011013:Pneumonectomy / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011656:Pulmonary Emphysema / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology