Joint effect of airflow limitation and emphysema on postoperative outcomes in early-stage nonsmall cell lung cancer.
This study aims to evaluate the joint effect of severity of airflow limitation and emphysema on postoperative pulmonary complications (PPCs) and overall survival after complete resection in patients with early-stage nonsmall cell lung cancer (NSCLC).We retrospectively studied 413 male patients with pathologic stage I or II NSCLC between 2007 and 2009. Severity of airflow limitation was defined based on forced expiratory volume in 1 s. Emphysema was defined by ≥5% low attenuation area at -950 HU.In multivariable-adjusted analyses, the adjusted odds ratio (aOR) for any PPC, comparing patients with moderate-to-severe airflow limitation to those without airflow limitation, was 2.23, and the aOR comparing patients with emphysema to those without emphysema was 1.77. However, the joint effect of airflow limitation and emphysema was much higher than expected from the independent effects of both factors (aOR 8.90). Moreover, patients with coexisting moderate-to-severe airflow limitation and emphysema had significantly poorer overall survival than any other group.Patients with moderate-to-severe airflow limitation and emphysema had almost nine times the risk of PPCs and poorer survival than patients with neither of these conditions. Integrated assessment of airflow limitation severity and emphysema is necessary for the optimal selection of candidates for lung resection surgery of early-stage NSCLC.
Dept of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Sumin
S
Shin
Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea hyeyunpark@skku.edu.|Both authors contributed equally.
Hye Yun
HY
Park
Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Hyunkyung
H
Kim
Dept of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Hong Kwan
HK
Kim
Dept of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Yong Soo
YS
Choi
Dept of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Jhingook
J
Kim
Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Sang-Won
SW
Um
Dept of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Myung Jin
MJ
Chung
Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Hojoong
H
Kim
Division of Pulmonary and Critical Care Medicine, Dept of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
O Jung
OJ
Kwon
Dept of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Jae Ill
JI
Zo
Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.|Depts of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Eliseo
E
Guallar
Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.|Depts of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Dept of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.
Juhee
J
Cho
Dept of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.|Both authors contributed equally.
Young Mog
YM
Shim
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000601:surgery; D004646:Emphysema / Q000503:physiopathology*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008168:Lung / Q000503:physiopathology*; D008175:Lung Neoplasms / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D056910:Republic of Korea; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed