Model of lung cancer surgery risk derived from a Japanese nationwide web-based database of 78 594 patients during 2014–2015†

Abstract

OBJECTIVESUsing data obtained from a Japanese nationwide annual database with web-based data entry, we developed a risk model of mortality and morbidity after lung cancer surgery.METHODSThe characteristics and operative and postoperative data from 80 095 patients who underwent lung cancer surgery were entered into the annual National Clinical Database of Japan data sets for 2014 and 2015. After excluding 1501 patients, the development data set for risk models included 38 277 patients entering in 2014 and the validation data set included 40 317 patients entering in 2015. Receiver–operating characteristic curves were generated for the outcomes of mortality and composite mortality/major morbidity. The concordance index was used to assess the discriminatory ability and validity of the model.RESULTSThe 30-day mortality and overall mortality rates, including in-hospital deaths, were 0.4% and 0.8%, respectively, in 2014, and 0.4% and 0.8%, respectively, in 2015. The rate of major morbidity was 5.6% in 2014 and 5.6% in 2015. Several risk factors were significantly associated with mortality, namely, male sex, performance status, comorbidities of interstitial pneumonia and liver cirrhosis, haemodialysis and the surgical procedure pneumonectomy. The concordance index for mortality and composite mortality/major morbidity was 0.854 (P < 0.001) and 0.718 (P < 0.001), respectively, for the development data set and 0.849 (P < 0.001) and 0.723 (P < 0.001), respectively, for the validation data set.CONCLUSIONSThis model was satisfactory for predicting surgical outcomes after pulmonary resection for lung cancer in Japan and will aid preoperative assessment and improve clinical outcomes for lung cancer surgery.

Risk assessments for broncho-pleural fistula and respiratory failure after lung cancer surgery by National Clinical Database Japan

“…Surgery remains the mainstay for complete cure. Several risk models and scoring systems for improving stratification of mortality risk associated with lung cancer surgery have been developed and tested [1][2][3].…”

Recommendations for perioperative management of lung cancer patients with comorbidities

“…Incidence is higher in men, smokers, and persons with lung cancer. According to the Japan National Clinical Database (NCD), the IP incidence rate among patients who underwent pulmonary resection for lung cancer was 4.7% during 2014–2015 [1]. Some IP patients with lung cancer develop acute exacerbation (AE) after pulmonary resection, a major complication that can lead to death.…”

“…Treatment of AE is difficult because of the rapid, aggressive progression to respiratory failure and the absence of definitive treatment and management options. A risk model for lung cancer surgery based on NCD data indicates that IP is an important risk comorbidity for operative mortality and morbidity [1]. Therefore, the presence of IP must be considered in surgical decision-making, and perioperative management is essential for improving clinical outcomes.…”

“…Dialysis patients were more likely than non-dialysis patients to develop adverse events within 30 days postoperatively (morbidity 28.6 vs 10.7%, respectively; P  < 0.001; mortality 12.7 vs 1.5%; P  < 0.001). Several small-scale studies [40–50] evaluated surgical risk associated with hemodialysis in patients undergoing pulmonary resection (Table 3), and a 2017 study of the Japan NCD clearly showed high mortality and morbidity in this population [1]. The small-scale studies showed that hyperkalemia was the most frequent complication after pulmonary resection (Table 4).…”

“…Recent studies of large clinical databases related to lung cancer surgery indicate that comorbidities affect operative mortality and morbidity. Risk model analysis showed that cardiovascular disorders, end-stage renal failure, and interstitial pneumonia are significant risk factors in operative mortality and morbidity [1]. Preoperative assessment of these risk factors might aid decisions regarding surgical treatment, and perioperative management of these comorbidities is necessary in order to improve surgical outcomes for lung cancer patients.…”