Key result
Age, low BMI, and low FEV1 predict worse NSCLC resection survival, whereas baseline comorbidities do not.
Why the study?
It was unclear whether preoperative comorbidities impact postoperative complication rates or survival after anatomical lung resection for non-small cell lung cancer.
Do preoperative comorbidities impact postoperative complication rates or survival in patients undergoing anatomical lung resection for NSCLC?
Cohort (n=1,219)
No
Do preoperative comorbidities impact postoperative complication rates or survival in patients undergoing anatomical lung resection for NSCLC?
Hazard Ratio: 1.02 (95% CI 1.01–1.03)
p-value: p=<0.001
In patients undergoing NSCLC resection, advanced age, low BMI, and low FEV1 predict greater complication risk and shorter survival, while specific comorbidities like hypertension increase the risk of cardiac complications.
May aid preoperative risk stratification for NSCLC resection; hypothesis-generating pending prospective validation.
OBJECTIVE: This study aimed to analyze whether comorbidities impact postoperative complication rate or survival after anatomical lung resection for non-small cell lung cancer (NSCLC). METHODS: A retrospective analysis of 1219 patients who underwent NSCLC resection between 2000 and 2015 was performed. Analyzed comorbidities included chronic obstructive lung disease (COPD), hypertension, coronary artery disease (CAD), peripheral artery disease, myocardial infarction history, diabetes mellitus, renal insufficiency and other malignancies. RESULTS: Most patients (78.9%) had comorbidities, most commonly hypertension (34.1%) followed by COPD (26.4%) and other malignancies (19%). The overall complication rate was 38.6% (26.4% pulmonary; 14.8% cardiac; and 3.0% gastrointestinal). Hypertension (odds ratio (OR) = 1.492, p = 0.031) was associated with more cardiac complications. Heavy smoking (OR = 1.008, p = 0.003) and low body mass index (BMI) (OR = 0.932, p < 0.001) affected the pulmonary complication rate significantly. None of the included comorbidities affected the overall complication rate or the survival negatively. However, the patient characteristics of advanced age (p < 0.001), low BMI (p = 0.008), and low FEV1 (p = 0.008) affected the overall complication rate as well as survival (each p < 0.001). CONCLUSION: Advanced age, low BMI, and low FEV1 were predictive of greater complication risk and shorter long-term survival in patients who underwent NSCLC resection. Cardiac complications were associated with hypertension and CAD, whereas pulmonary complications were associated with a high pack year count.
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Benker et al. (2021) conducted a cohort in Non-small cell lung cancer (NSCLC) (n=1,219). Preoperative comorbidities and patient characteristics (age, BMI, FEV1) vs. Absence of comorbidities or different patient characteristics was evaluated on Overall survival (per year of increased age) (HR 1.02, 95% CI 1.01-1.03, p=<0.001). Advanced age, low BMI, and low FEV1 predicted greater complication risk and shorter survival after NSCLC resection, whereas preoperative comorbidities did not significantly affect overall outcomes.
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