Predictors of long-term compensatory response of pulmonary function following major lung resection for non-small cell lung cancer

Yusuke Takahashi; Noriyuki Matsutani; Shigeki Morita; Hitoshi Dejima; Takashi Nakayama; Hirofumi Uehara; Masafumi Kawamura

doi:10.1111/resp.12904

Predictors of long-term compensatory response of pulmonary function following major lung resection for non-small cell lung cancer

Respirology. 2017 Feb;22(2):364-371. doi: 10.1111/resp.12904. Epub 2016 Sep 20.

Authors

Yusuke Takahashi¹, Noriyuki Matsutani¹, Shigeki Morita², Hitoshi Dejima¹, Takashi Nakayama¹, Hirofumi Uehara¹, Masafumi Kawamura¹

Affiliations

¹ Department of General Thoracic Surgery, Teikyo University School of Medicine, Tokyo, Japan.
² Department of Pathology, Teikyo University School of Medicine, Tokyo, Japan.

PMID: 27649690
DOI: 10.1111/resp.12904

Abstract

Background and objective: Long-term pulmonary function which might include compensatory response (CR) significantly influences quality of life of long-term survivor after major lung resection. We investigated long-term pulmonary function after major lung resection.

Methods: A total of 137 patients who had undergone lobar resection for non-small cell lung cancer (NSCLC) from May 2013 to June 2014 had spirometry at 10-14 months after surgery. Actual post-operative forced expiratory volume in 1 s (FEV₁ ) (FEV_1apo )/predicted post-operative FEV₁ (FEV_1ppo ), actual post-operative forced vital capacity (FVC) (FVC_apo )/predicted post-operative FVC (FVC_ppo ), its relationship with clinicopathological factors and immunohistochemistry for pro-surfactant protein C (pro-SPC), thyroid transcription factor-1 (TTF-1) and vascular endothelial growth factor receptor 2 (VEGFR2) were investigated.

Results: FEV_1apo /FEV_1ppo showed strong correlation with FVC_apo /FVC_ppo (r = 0.628; P < 0.001). We defined greater CR as both FEV_1apo /FEV_1ppo and FVC_apo /FVC_ppo were >120%. Greater CR was significantly associated with decreased smoking index (P < 0.001) and greater resected subsegments (P = 0.037). The never-smoker group revealed significantly greater CR compared with the smoker group in both FEV_1apo /FEV_1ppo (119.9 ± 12.5% vs 107.5 ± 14.2%; P = 0.030) and FVC_apo /FVC_ppo (117.9 ± 9.98% vs 107.2 ± 13.1%; P = 0.046) in case-matched comparison. The expression of pro-SPC, TTF-1 and VEGFR2 in the normal lung parenchyma of greater CR group was significantly higher than those of lesser CR group (P < 0.001 for each). In addition, pro-SPC, TTF-1 and VEGFR2 expressions showed a significant correlation to the degree of CR especially in the smoker group (r = 0.631, 0.705 and 0.732, respectively; P < 0.001 for each).

Conclusion: Our data suggest that smokers may develop lesser long-term CR after major lung resection. Decreased expression of pro-SPC, TTF-1 and VEGFR2 may indicate decreased capacity of CR, especially in patients who smoke.

Keywords: airway epithelium; lung cancer; respiratory function tests; thoracic surgery.

MeSH terms

Adult
Aged
Carcinoma, Non-Small-Cell Lung* / pathology
Carcinoma, Non-Small-Cell Lung* / surgery
Female
Forced Expiratory Volume
Humans
Japan
Long Term Adverse Effects* / diagnosis
Long Term Adverse Effects* / physiopathology
Lung Neoplasms* / pathology
Lung Neoplasms* / surgery
Lung* / pathology
Lung* / physiopathology
Male
Middle Aged
Pneumonectomy* / adverse effects
Pneumonectomy* / methods
Postoperative Complications* / diagnosis
Postoperative Complications* / physiopathology
Postoperative Period
Risk Factors
Spirometry / methods
Vascular Endothelial Growth Factor A / analysis

Substances

Vascular Endothelial Growth Factor A