Clinical impact of the lower limit of normal of FEV1/FVC on survival in lung cancer patients undergoing thoracic surgery.
BACKGROUND
Previously, it has been shown that using a fixed ratio of FEV1/FVC of 0.7 to classify airway obstruction could not predict survival outcomes in lung cancer patients undergoing thoracic surgery. We demonstrated that use of the lower limit of normal (LLN) of FEV1/FVC may allow better risk stratification for postoperative outcomes in patients with chronic obstructive pulmonary disease (COPD) patients. Nevertheless, it remained unclear whether survival outcomes in this population could be predicted by LLN-defined airway obstruction.


OBJECTIVE
To evaluate the clinical relevance of LLN-defined airway obstruction to survival outcomes.


METHODS
The clinical relevance of LLN-defined airway obstruction was analyzed and compared in 699 subjects, using Kaplan-Meier curves and the log-rank test. A Cox regression model was used to explore prognostic risk factors.


RESULTS
One hundred-and-seventy-eight subjects were assigned to the below-LLN group, in which airflow obstruction determined by the FEV1/FVC ratio was below the LLN. Five hundred-and-twenty-one subjects were assigned to the above-LLN group. The below-LLN group had a worse overall survival (OS) and disease-free survival (DFS) than the above-LLN group. The diffusing capacity of the lung for carbon monoxide and the ratio of the inspiratory capacity divided to the total lung capacity were independent risk factors for OS and DFS.


CONCLUSIONS
A standardized assessment of LLN-defined airway obstruction may allow risk stratification for survival likelihood in lung cancer patients who undergo thoracic surgery.
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: masuka@med.nagoya-u.ac.jp.
Asuka
A
Matsuzaki
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: hashinao@med.nagoya-u.ac.jp.
Naozumi
N
Hashimoto
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: s.okachi@med.nagoya-u.ac.jp.
Shotaro
S
Okachi
Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: ttani@med.nagoya-u.ac.jp.
Tetsuo
T
Taniguchi
Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: gucci@med.nagoya-u.ac.jp.
Koji
K
Kawaguchi
Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: tfukui@med.nagoya-u.ac.jp.
Takayuki
T
Fukui
Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: wakai@med.nagoya-u.ac.jp.
Kenji
K
Wakai
Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: k-yokoi@med.nagoya-u.ac.jp.
Kohei
K
Yokoi
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: yhasega@med.nagoya-u.ac.jp.
Yoshinori
Y
Hasegawa
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality* / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive; D012306:Risk; D013534:Survival; D019616:Thoracic Surgical Procedures; D016896:Treatment Outcome; D014797:Vital Capacity
Chronic obstructive lung disease; Lower limit of normal; Lung cancer; Survival; Thoracic surgery