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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,N. Cui,Randal J. Thomas,R. Squires,T. Olson,K. Sylvester,Siqian Fu,Chunfang Zhang,Yang Gao,Yang Du,Ning Xu,Suixin Liu

Published 2023 in International Journal of Surgery

ABSTRACT

Background: The role of minute ventilation/carbon dioxide production ( V˙E / V˙ CO2) 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 V˙E / V˙ CO2 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 V˙ E/ V˙ CO2 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 V˙ E/ V˙ CO2 slopes, respectively [weighted incidence rate difference per 1000 person-years, 29.21 (95% CI, 7.30–51.12)]. A V˙ E/ V˙ CO2 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 V˙E / V˙ CO2 slope. A high V˙ E/ V˙ CO2 slope increased the risk of perioperative morbidity compared with a low V˙ E/ V˙ CO2 slope [odds ratio, 2.32 (1.54–3.49), P<0.001]. Conclusions: In patients with operable NSCLC, a high V˙ E/ V˙ CO2 slope was significantly associated with elevated risks of poorer RFS, OS, and perioperative morbidity.

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