Julia Zimmermann, Johannes Schön, Valentina Pfeiffer, Tim-Mathis Beutel, Annalena Felker, Elvira Stacher-Priehse, Fuad Damirov, Niels Reinmuth, Rudolf A Hatz, Christian P Schneider, Mircea Gabriel Stoleriu
{"title":"COPD严重程度作为可手术肺癌长期生存的独立预测因子：来自大容量胸外科中心的回顾性分析","authors":"Julia Zimmermann, Johannes Schön, Valentina Pfeiffer, Tim-Mathis Beutel, Annalena Felker, Elvira Stacher-Priehse, Fuad Damirov, Niels Reinmuth, Rudolf A Hatz, Christian P Schneider, Mircea Gabriel Stoleriu","doi":"10.2147/COPD.S518084","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to identify predictors of long-term survival in patients with chronic obstructive pulmonary disease (COPD) undergoing anatomical resections for non-small cell lung cancer (NSCLC), with focus on COPD severity, to improve perioperative risk stratification and patient care.</p><p><strong>Patients and methods: </strong>This retrospective study included all patients with NSCLC and COPD undergoing anatomical resections at the Lung Tumor Center Munich between 2011 and 2020. COPD severity was classified by Global Initiative for Obstructive Lung Disease criteria: Group 1 (mild/moderate obstruction, COPD I-II) and Group 2 (severe obstruction, COPD III-IV). The relationship between COPD severity and perioperative parameters was analyzed using Kaplan-Meier and Cox proportional hazard model.</p><p><strong>Results: </strong>Of 1663 NSCLC patients undergoing anatomical resections, 476 (28.6%) patients with COPD I-IV (40.5% female, median age 67.28 [60.57; 73.27] years) were included. No significant differences were observed between groups in demographics, topography, TNM classification, histology of the primary tumor, and surgical approach. Group 2 experienced more frequently prolonged mechanical ventilation >2 days (p=0.016), air leaks >5 days (p = 0.020), and arrhythmias (p=0.012). Median overall survival (OS) was reduced in Group 2 (43.73 [30.14; 57.33] vs 85.30 [67.46; 103.14] months, p=0.001). Independent predictors of reduced OS included COPD III-IV (p<0.0001), pT<sub>3-4</sub> (p=0.007), pN<sub>1-2</sub> (p<0.0001), preoperative CRP >0.6 mg/dL (p=0.014) and VO<sub>2</sub>max <17 mL/min/kg (p=0.040). These predictors increased the risk of death by 1.6 [1.27-1.90], 1.3 [1.06-1.48], 2.1 [1.49-3.03], 1.6 [1.09-2.20] and 1. [1.02-2.00] fold, respectively.</p><p><strong>Conclusion: </strong>COPD severity independently predicts perioperative morbidity and long-term survival in operable NSCLC patients. 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Independent predictors of reduced OS included COPD III-IV (p<0.0001), pT<sub>3-4</sub> (p=0.007), pN<sub>1-2</sub> (p<0.0001), preoperative CRP >0.6 mg/dL (p=0.014) and VO<sub>2</sub>max <17 mL/min/kg (p=0.040). These predictors increased the risk of death by 1.6 [1.27-1.90], 1.3 [1.06-1.48], 2.1 [1.49-3.03], 1.6 [1.09-2.20] and 1. [1.02-2.00] fold, respectively.</p><p><strong>Conclusion: </strong>COPD severity independently predicts perioperative morbidity and long-term survival in operable NSCLC patients. 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引用次数: 0
摘要
目的：本研究旨在确定接受非小细胞肺癌（NSCLC）解剖切除的慢性阻塞性肺疾病（COPD）患者的长期生存预测因素，重点关注COPD严重程度，以改善围手术期风险分层和患者护理。患者和方法：这项回顾性研究包括2011年至2020年间在慕尼黑肺癌中心接受解剖切除的所有非小细胞肺癌和慢性阻塞性肺病患者。COPD严重程度根据全球阻塞性肺疾病倡议标准分类：1组（轻度/中度梗阻，COPD I-II）和2组（严重梗阻，COPD III-IV）。采用Kaplan-Meier和Cox比例风险模型分析COPD严重程度与围手术期参数的关系。结果：1663例行解剖切除的NSCLC患者中，476例（28.6%）COPD I-IV患者（40.5%为女性，中位年龄67.28[60.57；73.27]岁）。两组在人口统计学、地形、TNM分类、原发肿瘤组织学和手术入路方面均无显著差异。2组机械通气时间延长>2 d （p=0.016）、漏气>5 d （p= 0.020）、心律失常发生率更高（p=0.012）。2组的中位总生存期（OS）降低（43.73 [30.14;57.33]vs 85.30[67.46； 103.14]个月，p=0.001）。COPD III-IV （p3-4 (p=0.007)）、pN1-2 （p0.6 mg/dL (p=0.014)）和VO2max是降低OS的独立预测因子。结论：COPD严重程度独立预测可手术NSCLC患者围手术期发病率和长期生存。全面评估COPD严重程度有助于识别高危患者并优化围手术期护理。
COPD Severity as an Independent Predictor of Long-Term Survival in Operable Lung Cancer: A Retrospective Analysis from a High-Volume Thoracic Surgery Center.
Purpose: This study aims to identify predictors of long-term survival in patients with chronic obstructive pulmonary disease (COPD) undergoing anatomical resections for non-small cell lung cancer (NSCLC), with focus on COPD severity, to improve perioperative risk stratification and patient care.
Patients and methods: This retrospective study included all patients with NSCLC and COPD undergoing anatomical resections at the Lung Tumor Center Munich between 2011 and 2020. COPD severity was classified by Global Initiative for Obstructive Lung Disease criteria: Group 1 (mild/moderate obstruction, COPD I-II) and Group 2 (severe obstruction, COPD III-IV). The relationship between COPD severity and perioperative parameters was analyzed using Kaplan-Meier and Cox proportional hazard model.
Results: Of 1663 NSCLC patients undergoing anatomical resections, 476 (28.6%) patients with COPD I-IV (40.5% female, median age 67.28 [60.57; 73.27] years) were included. No significant differences were observed between groups in demographics, topography, TNM classification, histology of the primary tumor, and surgical approach. Group 2 experienced more frequently prolonged mechanical ventilation >2 days (p=0.016), air leaks >5 days (p = 0.020), and arrhythmias (p=0.012). Median overall survival (OS) was reduced in Group 2 (43.73 [30.14; 57.33] vs 85.30 [67.46; 103.14] months, p=0.001). Independent predictors of reduced OS included COPD III-IV (p<0.0001), pT3-4 (p=0.007), pN1-2 (p<0.0001), preoperative CRP >0.6 mg/dL (p=0.014) and VO2max <17 mL/min/kg (p=0.040). These predictors increased the risk of death by 1.6 [1.27-1.90], 1.3 [1.06-1.48], 2.1 [1.49-3.03], 1.6 [1.09-2.20] and 1. [1.02-2.00] fold, respectively.
Conclusion: COPD severity independently predicts perioperative morbidity and long-term survival in operable NSCLC patients. Comprehensive assessment of COPD severity can help in identifying high-risk patients and optimizing perioperative care.
期刊介绍：
An international, peer-reviewed journal of therapeutics and pharmacology focusing on concise rapid reporting of clinical studies and reviews in COPD. Special focus will be given to the pathophysiological processes underlying the disease, intervention programs, patient focused education, and self management protocols. This journal is directed at specialists and healthcare professionals
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