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Long-Term Prognostic Impact Of Severe Postoperative Complications After Lung Cancer Surgery

Satoru Okada, Junichi Shimada, D. Kato, H. Tsunezuka, S. Teramukai, M. Inoue
Published 2018 · Medicine

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BackgroundPostoperative complications are reportedly related to poor prognosis following lung cancer surgery; however, the difference in the prognostic impact according to immune-nutritional status is unknown.MethodsIn 411 patients with completely resected non-small cell lung cancer, the relationship between severe postoperative complications (SPCs; Clavien–Dindo grade III or higher) and survival was retrospectively analyzed, with special reference to preoperative immune-nutritional status based on the prognostic nutritional index (PNI), which was calculated using serum albumin level and total lymphocyte count.ResultsA total of 52 (12.7%) patients had SPCs. The most common SPC was air leak (n = 39), atelectasis/sputum (n = 4), pneumonia (n = 2), pyothorax (n = 2), and bleeding (n = 2). The 5-year overall survival (OS) rates in patients with and without SPCs were 63.8% and 80.1%, respectively (p = 0.007). A multivariate Cox proportional hazard model revealed SPCs had a negative prognostic impact on patients with preserved immune-nutritional status (PNI ≥ 48.3; first to third quartile), but not on those with poor immune-nutritional status (PNI < 48.3; fourth quartile), with statistically significant interaction. Further analysis focused on 309 patients with preserved immune-nutritional status. The OS and relapse-free survival (RFS) rates were significantly worse in patients with SPCs than in those without (p < 0.001). After controlling for potential confounders, SPCs remained significantly associated with worse OS (adjusted hazard ratio [HR] 2.49, 95% confidence interval [CI] 1.21–4.83; p = 0.015) and RFS (adjusted HR 2.02, 95% CI 1.10–3.53; p = 0.025).ConclusionSevere complications following lung cancer surgery could negatively impact prognosis, particularly in patients with preserved immune-nutritional status.
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