Prediction of Surgical Outcome by Modeling Based on Risk Factors of Morbidity After Pulmonary Resection for Lung Cancer in Older Adults.
BACKGROUND
Surgical treatment for older patients with lung cancer presents more challenges compared with general population. The aim of the study was to predict surgical outcome after pulmonary resection in older patients with lung cancer by developing a clinical model.


METHODS
Clinical records of 525 patients who were older than 70 years of age and who underwent pulmonary resection for lung cancer in a single center were reviewed. Patients were divided into three ordered categories of surgical outcome according to the Clavien-Dindo classification. By using a development cohort of 401 patients, an ordinal logistic regression was performed to develop a prediction model for surgical outcome. The model was internally validated by the bootstrap method and was externally validated by another cohort of 124 patients. Two previous models were tested as benchmarks of our model.


RESULTS
The model was developed based on five risk factors of morbidity: American Society of Anesthesiologists classification (p < 0.001), pulmonary disease (p = 0.001), tumor size (p = 0.011), tumor location (p = 0.015), and surgical approach (p = 0.036). The c-statistic of the model was 0.75 (95% confidence interval: 0.69 to 0.80), which was similar to the bootstrapping one (0.75; 95% confidence interval: 0.68 to 0.80). The Hosmer-Lemeshow test showed a strong goodness of fit of the model (p = 0.674). In external validation, the performance of our model was superior to that of the two previous models.


CONCLUSIONS
Our model displayed an acceptable ability to predict surgical outcome in older patients undergoing pulmonary resection for lung cancer. Use of the model can be helpful in decision making about surgical treatment in this special population.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, China.
Yuzhao
Y
Wang
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, China.
Nan
N
Wu
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, China.
Qingfeng
Q
Zheng
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, China.
Jia
J
Wang
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, China.
Shi
S
Yan
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, China.
Shaolei
S
Li
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, China.
Yinan
Y
Liu
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, China.
Jinfeng
J
Chen
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, China. Electronic address: zlyangyue@bjmu.edu.cn.
Yue
Y
Yang
D000368:Aged; D005260:Female; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D009017:Morbidity; D011013:Pneumonectomy; D012307:Risk Factors; D016896:Treatment Outcome