J Chest Surg.  2022 Feb;55(1):20-29. 10.5090/jcs.21.100.

Prognostic Impact of Postoperative Complications in High-Risk Operable Non-small Cell Lung Cancer

• Lee S
• Roknuggaman M
• Son JA
• Hyun S
• Jung J
• Haam S
• Yu WS

• KMID: 2525267
• DOI: http://doi.org/10.5090/jcs.21.100

Abstract

Background
Patients with high-risk (HR) operable non-small cell lung cancer (NSCLC) may have unique prognostic factors. This study aimed to evaluate surgical outcomes in HR patients and to investigate prognostic factors in HR patients versus standard-risk (SR) patients.
Methods
In total, 471 consecutive patients who underwent curative lung resection for NSCLC between January 2012 and December 2017 were identified and reviewed retrospectively. Patients were classified into HR (n=77) and SR (n=394) groups according to the American College of Surgeons Oncology Group criteria (Z4099 trial). Postoperative complications were defined as those of grade 2 or higher by the Clavien-Dindo classification.
Results
The HR group comprised more men and older patients, had poorer lung function, and had more comorbidities than the SR group. The patients in the HR group also experienced more postoperative complications (p≤0.001). More HR patients died without disease recurrence. The postoperative complication rate was the only significant prognostic factor in multivariable Cox regression analysis for HR patients but not SR patients. HR patients without postoperative complications had a survival rate similar to that of SR patients.
Conclusion
The overall postoperative survival of HR patients with NSCLC was more strongly affected by postoperative complications than by any other prognostic factor. Care should be taken to minimize postoperative complications, especially in HR patients.

Keyword

Lung neoplasms; Non-small-cell lung carcinoma; Postoperative care; Prognosis, Surgery