Postinduction therapy pulmonary function retesting is necessary before surgical resection for non–small cell lung cancer Journal Article


Authors: Connolly, J. G.; Fiasconaro, M.; Tan, K. S.; Cirelli, M. A. Jr; Jones, G. D.; Caso, R.; Mansour, D. E.; Dycoco, J.; No, J. S.; Molena, D.; Isbell, J. M.; Park, B. J.; Bott, M. J.; Jones, D. R.; Rocco, G.
Article Title: Postinduction therapy pulmonary function retesting is necessary before surgical resection for non–small cell lung cancer
Abstract: Objective: Pretreatment-predicted postoperative diffusing capacity of the lung for carbon monoxide (DLCO) has been associated with operative mortality in patients who receive induction therapy for resectable non–small cell lung cancer (NSCLC). It is unknown whether a reduction in pulmonary function after induction therapy and before surgery affects the risk of morbidity or mortality. We sought to determine the relationship between induction therapy and perioperative outcomes as a function of postinduction pulmonary status in patients who underwent surgical resection for NSCLC. Methods: We retrospectively reviewed data for 1001 patients with pathologic stage I, II, or III NSCLC who received induction therapy before lung resection. Pulmonary function was defined according to American College of Surgeons Oncology Group major criteria: DLCO ≥50% = normal; DLCO <50% = impaired. Patients were categorized into 5 subgroups according to combined pre- and postinduction DLCO status: normal-normal, normal-impaired, impaired-normal, impaired-impaired, and preinduction only (without postinduction pulmonary function test measurements). Multivariable logistic regression was used to quantify the relationship between DLCO categories and dichotomous end points. Results: In multivariable analysis, normal-impaired DLCO status was associated with an increased risk of respiratory complications (odds ratio, 2.29 [95% CI, 1.12-4.49]; P = .02) and in-hospital complications (odds ratio, 2.83 [95% CI, 1.55-5.26]; P < .001). Type of neoadjuvant therapy was not associated with an increased risk of complications, compared with conventional chemotherapy. Conclusions: Reduced postinduction DLCO might predict perioperative outcomes. The use of repeat pulmonary function testing might identify patients at higher risk of morbidity or mortality. © 2021 The American Association for Thoracic Surgery
Keywords: retrospective studies; metabolism; carcinoma, non-small-cell lung; lung neoplasms; pathology; retrospective study; lung tumor; lung; lung function test; non small cell lung cancer; carbon monoxide; pulmonary diffusing capacity; respiratory function tests; lung diffusion capacity; dlco; humans; human; pulmonary function testing; non–small cell lung cancer; diffusing capacity of the lung for carbon monoxide
Journal Title: Journal of Thoracic and Cardiovascular Surgery
Volume: 164
Issue: 2
ISSN: 0022-5223
Publisher: Mosby Elsevier  
Date Published: 2022-08-01
Start Page: 389
End Page: 397.e7
Language: English
DOI: 10.1016/j.jtcvs.2021.12.030
PUBMED: 35086669
PROVIDER: scopus
PMCID: PMC9218003
DOI/URL:
Notes: Article -- Export Date: 1 August 2022 -- Source: Scopus
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MSK Authors
  1. Bernard J Park
    209 Park
  2. Matthew Bott
    90 Bott
  3. Joseph Dycoco
    36 Dycoco
  4. David Randolph Jones
    303 Jones
  5. Daniela   Molena
    183 Molena
  6. Kay See   Tan
    175 Tan
  7. James Michael Isbell
    86 Isbell
  8. Gregory Jones
    21 Jones
  9. Raul Caso Jr
    21 Caso Jr
  10. Gaetano Rocco
    67 Rocco
  11. Jae Seong No
    1 No