Impact of diffusing lung capacity before and after neoadjuvant concurrent chemoradiation on postoperative pulmonary complications among patients with stage IIIA/N2 non-small-cell lung cancer

Abstract

Background and objective: This study aims to evaluate the impact of diffusing capacity of the lung for carbon monoxide (DLco) before and after neoadjuvant concurrent chemoradiotherapy (CCRT) on postoperative pulmonary complication (PPC) among stage IIIA/N2 non-small-cell lung cancer (NSCLC) patients. Methods:We retrospectively studied 324 patients with stage IIIA/N2 NSCLC between 2009 and 2016. Patients were classified into 4 groups according to DLco before and after neoadjuvant CCRT; normal-to-normal (NN), normal-tolow (NL), low-to-low (LL), and low-to-very low (LVL). Low DLco and very low DLco were defined as DLco < 80% predicted and DLco < 60% predicted, respectively. Results: On average, DLco was decreased by 12.3% (±10.5) after CCRT. In multivariable-adjusted analyses, the incidence rate ratio (IRR) for any PPC comparing patients with low DLco to those with normal DLco before CCRT was 2.14 (95% confidence interval (CI) = 1.36-3.36). Moreover, the IRR for any PPC was 3.78 (95% CI = 1.68-8.49) in LVL group compared to NN group. The significant change of DLco after neoadjuvant CCRT had an additional impact on PPC, particularly after bilobectomy or pneumonectomy with low baseline DLco.Conclusions: The DLco before CCRT was significantly associated with risk of PPC, and repeated test of DLco after CCRT would be helpful for risk assessment, particularly in patients with low DLco before neoadjuvant CCRT.

A Prediction Model for Postoperative Pulmonary Complication in Pulmonary Function-Impaired Patients Following Lung Resection

“…Several studies have demonstrated that the incidence of PPC increases with severe impaired pulmonary function. [13][14][15][16][17]33,34 FEV1/FVC% reflects airway obstruction and airway resistance, hence significant decreases in this parameter indicate that patients have pulmonary ventilation dysfunction and the possibility of pulmonary complications after lung resection is increased. Fernandes et al reported that FEV1/FVC% < 60% is a predictor of postoperative mortality and PPC.…”

“…12 The rate of PPC is established as related to impaired pulmonary function. [13][14][15][16][17] Alam et al reported significant differences in the percentages of predicted forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) in patients who developed atelectasis and respiratory tract infection following cardiac surgery. 14 Shin et al found that diffusing capacity of the lung for carbon monoxide (DLco) value before neoadjuvant concurrent chemoradiotherapy was significantly associated with risk of PPC.…”

“…14 Shin et al found that diffusing capacity of the lung for carbon monoxide (DLco) value before neoadjuvant concurrent chemoradiotherapy was significantly associated with risk of PPC. 15 Further, peak expiratory flow (PEF) and maximal ventilatory volume (MVV) may be valuable for predicting PPC following lung surgery. 16,17 Previous studies to identify factors influencing PPC were clearly limited by the inclusion of only single potentiallyassociated indices.…”

Efficacy of iliopsoas muscle release on respiratory parameters in patients with chronic low back pain: a single blinded, two- groups, pre-test/post-test randomized controlled trial protocol

“…A capacidade de difusão do pulmão para monóxido de carbono será realizada usando o sistema Vmax 22 (Sensor Medics, Yorba Linda, CA, EUA), de acordo com os critérios da American Thoracic Society / European Respiratory Society. 28 DLCO consiste em uma mistura de gases que é monóxido de carbono (0,3 %), acetileno (0,3%), metano (0,3%), oxigênio (21%), nitrogênio. 29…”

Risk factors for pulmonary complications after neoadjuvant chemoradiotherapy followed by surgery for non‐small cell lung cancer

“…[10][11][12] However, only a few studies have investigated the incidence and risk factors for PPCs after neoadjuvant concurrent CRTx for NSCLC. 13,14 Moreover, predictive or discriminative factors, including neoadjuvant CRTx following surgery, for assigning patients with advanced NSCLC to multimodality treatment are still not established. Therefore, this study aimed to investigate the incidence and risk factors of PPCs after neoadjuvant concurrent CRTx and to construct a nomogram to help identify the subset of patients at an increased risk of PPCs.…”