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

BACKGROUND: The role of minute ventilation/carbon dioxide production ( [Formula: see text] / [Formula: see text] 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 [Formula: see text] / [Formula: see text] 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 [Formula: see text] E/ [Formula: see text] 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 [Formula: see text] E/ [Formula: see text] CO(2) slopes, respectively [weighted incidence rate difference per 1000 person-years, 29.21 (95% CI, 7.30–51.12)]. A [Formula: see text] E/ [Formula: see text] 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 [Formula: see text] / [Formula: see text] CO(2) slope. A high [Formula: see text] E/ [Formula: see text] CO(2) slope increased the risk of perioperative morbidity compared with a low [Formula: see text] E/ [Formula: see text] CO(2) slope [odds ratio, 2.32 (1.54–3.49), P<0.001]. CONCLUSIONS: In patients with operable NSCLC, a high [Formula: see text] E/ [Formula: see text] CO(2) slope was significantly associated with elevated risks of poorer RFS, OS, and perioperative morbidity.