Risk factors for non-cancer death after surgery in patients with stage I non-small-cell lung cancer

Abstract

OBJECTIVES With improvements in the outcome of treatment for non-small-cell lung cancer (NSCLC), other diseases may account for a high death rate after surgery in patients with stage I NSCLC. In the present study, we analysed the associations between the clinical factors and non-cancer death after surgery in these patients. METHODS The records of 514 patients with stage I NSCLC who underwent surgery were retrospectively reviewed; a proportional hazards model for the subdistribution of a competing risk was conducted to define the risk factors for non-cancer death. RESULTS The mean patient age was 67 years. A total of 367 patients (71%) underwent bilobectomy or lobectomy while 147 (29%) underwent sublobar resection. The pathological stage was IA in 386 (75%) and IB in 128 (25%) patients. Three patients (0.6%) died within 90 days after surgery, and 108 (21%) experienced postoperative complications. Until the time of writing this report, 83 patients had died during the follow-up. The cause of death was primary lung cancer in 38 (46%) patients and other diseases in 45 (54%) patients, including non-cancer causes in 29 patients, such as pneumonia, cardiac death and cerebral stroke. According to a multivariable competing risk analysis for non-cancer death age (≥70 years), sex (male), body mass index (BMI <18.5), postoperative complications and % forced expiratory volume in 1 s (<80) were identified as risk factors for postoperative non-cancer death. CONCLUSIONS Advanced age (≥70 years), male sex, low BMI (<18.5), postoperative complications and low preoperative % forced expiratory volume in 1 s (<80) were found to be the risk factors for postoperative non-cancer death after surgery in patients with stage I NSCLC.

Clinical utility of psoas muscle volume in assessment of sarcopenia in patients with early-stage non-small cell lung cancer

“…However, these patients often have reduced tolerance to surgical intervention. Thus, it is critical to consider factors, such as age, body mass index (BMI), performance status, smoking status, comorbidities, and the presence of sarcopenia, when determining the course of treatment (Leduc et al 2017; Kanzaki et al 2021; Kawaguchi et al 2010; Kravchenko et al 2015;Nakamura et al 2018).…”

Radioisotope-Guided Excision of Mediastinal Lymph Nodes in Patients with Non-Small Cell Lung Carcinoma: Feasibility and Clinical Impact

“…Studying the behaviour of the nodal spread in these patients might improve our capability to offer a radical treatment, even in these aggressive forms. On the other hand, prospective investigations assessing the possibility of more limited nodal resection in early-stage NSCLC might help reduce the rate of complications and postoperative morbidity [ 26 , 27 ]. Finally, even higher detection rates could be reached by switching from the one-dimensional exploration capability afforded by the gamma-probe to the 2D imaging offered by portable gamma cameras [ 28 ] or even to 3D, in vivo representation of sentinel nodes following pre-operative SPECT imaging, which has been suggested in many surgical fields [ 29 , 30 ].…”

Preoperative Master’s double two-step test may predict survival after lobectomy in patients with lung cancer

“…They also revealed that the cancer-specific survival of patients who climbed < 18 m was worse than that of patients who climbed > 18 m. Our study suggests that patients who could not complete the MDT tended to have worse overall survival, and those patients are more likely to die from diseases other than cancer. Kanzaki et al revealed that age (≥ 70), male sex, body mass index (< 18.5 kg/m 2 ), postoperative complications and low preoperative % forced expiratory volume 1 (< 80) were risk factors for postoperative non-cancer death after surgery in patients with stage I NSCLC [ 19 ]. Their results are reflected by the frailty of the patients who could not complete the MDT.…”