Abstract
Background
Postoperative complications are reportedly related to poor prognosis following lung cancer surgery; however, the difference in the prognostic impact according to immune-nutritional status is unknown.
Methods
In 411 patients with completely resected non-small cell lung cancer, the relationship between severe postoperative complications (SPCs; Clavien–Dindo grade III or higher) and survival was retrospectively analyzed, with special reference to preoperative immune-nutritional status based on the prognostic nutritional index (PNI), which was calculated using serum albumin level and total lymphocyte count.
Results
A total of 52 (12.7%) patients had SPCs. The most common SPC was air leak (n = 39), atelectasis/sputum (n = 4), pneumonia (n = 2), pyothorax (n = 2), and bleeding (n = 2). The 5-year overall survival (OS) rates in patients with and without SPCs were 63.8% and 80.1%, respectively (p = 0.007). A multivariate Cox proportional hazard model revealed SPCs had a negative prognostic impact on patients with preserved immune-nutritional status (PNI ≥ 48.3; first to third quartile), but not on those with poor immune-nutritional status (PNI < 48.3; fourth quartile), with statistically significant interaction. Further analysis focused on 309 patients with preserved immune-nutritional status. The OS and relapse-free survival (RFS) rates were significantly worse in patients with SPCs than in those without (p < 0.001). After controlling for potential confounders, SPCs remained significantly associated with worse OS (adjusted hazard ratio [HR] 2.49, 95% confidence interval [CI] 1.21–4.83; p = 0.015) and RFS (adjusted HR 2.02, 95% CI 1.10–3.53; p = 0.025).
Conclusion
Severe complications following lung cancer surgery could negatively impact prognosis, particularly in patients with preserved immune-nutritional status.
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Satoru Okada, Junichi Shimada, Daishiro Kato, Hiroaki Tsunezuka, Satoshi Teramukai, and Masayoshi Inoue declare there are no conflicts of interest to disclose.
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Supplemental Figure 1
Overall and relapse-free survival in patients with completely resected non-small cell lung cancer was stratified according to preoperative PNI status and severe postoperative complications (A, B). PNI, prognostic nutritional index (TIFF 15397 kb)
Supplemental Figure 2
Among patients with a preserved immune-nutritional status (PNI ≥ 48.3, n = 309), overall and relapse-free survival with completely resected non-small cell lung cancer was stratified according to the type of severe postoperative complication (A, B). PNI, prognostic nutritional index (TIFF 15397 kb)
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Okada, S., Shimada, J., Kato, D. et al. Long-Term Prognostic Impact of Severe Postoperative Complications After Lung Cancer Surgery. Ann Surg Oncol 26, 230–237 (2019). https://doi.org/10.1245/s10434-018-7061-x
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DOI: https://doi.org/10.1245/s10434-018-7061-x