Prognostic role of minute ventilation/carbon dioxide production slope for perioperative morbidity and long-term survival in resectable patients with nonsmall-cell lung cancer: a prospective study using propensity score overlap weighting

Yaoshan Dun; Shaoping Wu; Ni Cui; Randal J Thomas; Ray W Squires; Thomas P Olson; Karl P Sylvester; Siqian Fu; Chunfang Zhang; Yang Gao; Yang Du; Ning Xu; Suixin Liu

doi:10.1097/JS9.0000000000000509

Prognostic role of minute ventilation/carbon dioxide production slope for perioperative morbidity and long-term survival in resectable patients with nonsmall-cell lung cancer: a prospective study using propensity score overlap weighting

Int J Surg. 2023 Sep 1;109(9):2650-2659. doi: 10.1097/JS9.0000000000000509.

Authors

Yaoshan Dun^{1

2

3

4}, Shaoping Wu¹, Ni Cui¹, Randal J Thomas⁴, Ray W Squires⁴, Thomas P Olson⁴, Karl P Sylvester^{5

6}, Siqian Fu^{1

2}, Chunfang Zhang⁷, Yang Gao⁷, Yang Du^{2

8}, Ning Xu⁹, Suixin Liu^{1

4}

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Division of Cardiac Rehabilitation.
² National Clinical Research Center for Geriatric Disorders.
³ School of Cardiovascular and Metabolic Medicine & Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
⁴ Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
⁵ Lung Function Unit, Cambridge University Hospitals NHSFT.
⁶ Respiratory Physiology, Royal Papworth Hospital NHSFT, Cambridge.
⁷ Department of Thoracic Surgery.
⁸ Department of Neurology, Xiangya Hospital of Central South University, Changsha, Hunan.
⁹ Department of Data Analytics and Application, Ping An Technology, Shanghai, China.

Abstract

Background: The role of minute ventilation/carbon dioxide production ( / CO 2 ) slope, a ventilation efficiency marker, in predicting short-term and long-term health outcomes for patients with nonsmall-cell lung cancer (NSCLC) undergoing lung resection has not been well investigated.

Material and methods: This prospective cohort study consecutively enrolled NSCLC patients who underwent a presurgical cardiopulmonary exercise test from November 2014 to December 2019. The association of / CO 2 slope with relapse-free survival (RFS), overall survival (OS), and perioperative mortality was evaluated using the Cox proportional hazards and logistic models. Covariates were adjusted using propensity score overlap weighting. The optimal cut-off point of the E/ CO 2 slope was estimated using the receiver operating characteristics curve. Internal validation was completed through bootstrap resampling.

Results: A cohort of 895 patients [median age (interquartile range), 59 (13) years; 62.5% male] was followed for a median of 40 (range, 1-85) months. Throughout the study, there were 247 relapses or deaths and 156 perioperative complications. The incidence rates per 1000 person-years for relapses or deaths were 108.8 and 79.6 among patients with high and low E/ CO 2 slopes, respectively [weighted incidence rate difference per 1000 person-years, 29.21 (95% CI, 7.30-51.12)]. A E/ CO 2 slope of greater than or equal to 31 was associated with shorter RFS [hazard ratio for relapse or death, 1.38 (95% CI, 1.02-1.88), P =0.04] and poorer OS [hazard ratio for death, 1.69 (1.15-2.48), P =0.02] compared to a lower / CO 2 slope. A high E/ CO 2 slope increased the risk of perioperative morbidity compared with a low E/ CO 2 slope [odds ratio, 2.32 (1.54-3.49), P <0.001].

Conclusions: In patients with operable NSCLC, a high E/ CO 2 slope was significantly associated with elevated risks of poorer RFS, OS, and perioperative morbidity.