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Risk Assessment for Loss-of-Exercise Capacity After Lung Cancer Surgery: Current Advances in Surgery and Systemic Treatment

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Abstract

Background

Considering advances in current post-recurrence treatment, we examined the prognostic significance of the number of risk factors for loss-of-exercise capacity (LEC) after lung cancer surgery, which were identified by our previous prospective observational study.

Methods

Risk factors for LEC were defined as a short baseline 6-min walk distance (<400 m), older age (≥75 years), and low predicted postoperative diffusing capacity for carbon monoxide (<60%). Patients were classified as Risk 0/I/II/III according to the number of risk factors. The survival data were retrospectively analyzed.

Results

Between 2014 and 2017, 564 patients (n = 307, 193, 57, 7; Risk 0/I/II/III) who underwent lung cancer surgery were included in the study. The number of risk factors was associated with smoking status, predicted postoperative forced expiratory volume in 1 s, histology, pathological stage, and adjuvant therapy. In a multivariate Cox regression analysis, compared to Risk 0, Risk I/II/III showed significant associations with overall survival (hazard ratios: 1.92, 3.35, 9.21; 95% confidence interval: 1.27–2.92, 2.01–5.58, 3.64–23.35; Risk I/II/III, respectively). In 141 patients with recurrence, molecular targeted therapies (MTTs) or immune checkpoint inhibitors (ICIs) were included in 58%, 47%, 32%, and 0% (Risk 0/I/II/III) during the course of treatment. In patients with MTT/ICI treatment, the estimated 1-year and 3-year post-recurrence survival rates were 88% and 58%, respectively.

Conclusions

Risk classification for LEC was associated with survival after lung cancer surgery, as well as post-recurrence treatment. The concept of physical performance-preserving surgery may contribute to improving the outcomes of current lung cancer treatment.

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Abbreviations

6 MWD:

6-Minute walk distance

ADC:

Adenocarcinoma

ALK:

Anaplastic lymphoma kinase

BMI:

Body mass index

BSC:

Best supportive care

CI:

Confidence interval

CT:

Computed tomography

DFS:

Disease-free survival

DLCO :

Diffusing capacity of the lungs for carbon monoxide

EGFR:

Epidermal growth factor receptor

FEV1.0 :

Forced expiratory volume in one second

HR:

Hazard ratio

ICI:

Immune checkpoint inhibitor

IQR:

Interquartile range

LEC:

Loss-of-exercise capacity

MTT:

Molecular targeted therapy

NSCLC:

Non-small cell lung cancer

OS:

Overall survival

PD-1:

Programmed death-1

PD-L1:

Programmed death ligand-1

ppo:

Predicted postoperative

PRS:

Post-recurrence survival

SCC:

Squamous cell carcinoma

TKI:

Tyrosine kinase inhibitor

VATS:

Video-assisted thoracoscopic surgery

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Funding

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Authors and Affiliations

  1. Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Naoki Ozeki, Yuka Kadomatsu, Masaki Goto, Shota Nakamura, Koichi Fukumoto & Toyofumi Fengshi Chen-Yoshikawa

  2. Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan

    Yota Mizuno, Takayuki Inoue & Motoki Nagaya

Authors
  1. Naoki Ozeki
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  2. Yuka Kadomatsu
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  3. Yota Mizuno
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  4. Takayuki Inoue
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  5. Motoki Nagaya
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  6. Masaki Goto
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  7. Shota Nakamura
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  8. Koichi Fukumoto
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  9. Toyofumi Fengshi Chen-Yoshikawa
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Contributions

NO contributed to conceptualization; NO contributed to methodology; NO contributed to formal analysis; YK, YM, TI, MN, MG, SN and KF contributed to investigation; NO and MG contributed to data curation; NO contributed to writing—original draft preparation; YK, MG, SN, KF and TF.C-Y. contributed to writing—review and editing; TF.C-Y. contributed to supervision; TF.C-Y contributed to project administration.

Corresponding author

Correspondence to Naoki Ozeki.

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Conflict of interest

Nothing to declare.

Ethical approval

The Institutional Review Board of our hospital approved this study and waived the requirement for individual patient consent (2020-0375, 02/11/2020).

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Ozeki, N., Kadomatsu, Y., Mizuno, Y. et al. Risk Assessment for Loss-of-Exercise Capacity After Lung Cancer Surgery: Current Advances in Surgery and Systemic Treatment. World J Surg 46, 933–941 (2022). https://doi.org/10.1007/s00268-021-06427-3

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  • DOI: https://doi.org/10.1007/s00268-021-06427-3

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