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Pneumonectomy for primary lung cancer: contemporary outcomes, risk factors and model validation
OBJECTIVES: Despite the increased rate of adverse outcomes compared to lobectomy, for selected patients with lung cancer, pneumonectomy is considered the optimal treatment option. The objective of this study was to identify risk factors for mortality in patients undergoing pneumonectomy for primary...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9159428/ https://www.ncbi.nlm.nih.gov/pubmed/34871415 http://dx.doi.org/10.1093/icvts/ivab340 |
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author | Brunswicker, Annemarie Taylor, Marcus Grant, Stuart W Abah, Udo Smith, Matthew Shackcloth, Michael Granato, Felice Shah, Rajesh Rammohan, Kandadai |
author_facet | Brunswicker, Annemarie Taylor, Marcus Grant, Stuart W Abah, Udo Smith, Matthew Shackcloth, Michael Granato, Felice Shah, Rajesh Rammohan, Kandadai |
author_sort | Brunswicker, Annemarie |
collection | PubMed |
description | OBJECTIVES: Despite the increased rate of adverse outcomes compared to lobectomy, for selected patients with lung cancer, pneumonectomy is considered the optimal treatment option. The objective of this study was to identify risk factors for mortality in patients undergoing pneumonectomy for primary lung cancer. METHODS: Data from all patients undergoing pneumonectomy for primary lung cancer at 2 large thoracic surgical centres between 2012 and 2018 were analysed. Multivariable logistic and Cox regression analyses were used to identify risk factors associated with 90-day and 1-year mortality and reduced long-term survival, respectively. RESULTS: The study included 256 patients. The mean age was 65.2 (standard deviation 9.4) years. In-hospital, 90-day and 1-year mortality were 6.3% (n = 16), 9.8% (n = 25) and 28.1% (n = 72), respectively. The median follow-up time was 31.5 months (interquartile range 9–58 months). Patients who underwent neoadjuvant therapy had a significantly increased risk of 90-day [odds ratio 6.451, 95% confidence interval (CI) 1.867–22.291, P = 0.003] and 1-year mortality (odds ratio 2.454, 95% CI 1.079–7.185, P = 0.044). Higher Performance Status score was associated with higher 1-year mortality (odds ratio 2.055, 95% CI 1.248–3.386, P = 0.005) and reduced overall survival (hazard ratio 1.449, 95% CI 1.086–1.934, P = 0.012). Advanced (stage III/IV) disease was associated with reduced overall survival (hazard ratio 1.433, 95% CI 1.019–2.016, P = 0.039). Validation of a pneumonectomy-specific risk model demonstrated inadequate model performance (area under the curve 0.54). CONCLUSIONS: Pneumonectomy remains associated with a high rate of perioperative mortality. Neoadjuvant chemoradiotherapy, Performance Status score and advanced disease emerged as the key variables associated with adverse outcomes after pneumonectomy in our cohort. |
format | Online Article Text |
id | pubmed-9159428 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-91594282022-06-05 Pneumonectomy for primary lung cancer: contemporary outcomes, risk factors and model validation Brunswicker, Annemarie Taylor, Marcus Grant, Stuart W Abah, Udo Smith, Matthew Shackcloth, Michael Granato, Felice Shah, Rajesh Rammohan, Kandadai Interact Cardiovasc Thorac Surg Thoracic OBJECTIVES: Despite the increased rate of adverse outcomes compared to lobectomy, for selected patients with lung cancer, pneumonectomy is considered the optimal treatment option. The objective of this study was to identify risk factors for mortality in patients undergoing pneumonectomy for primary lung cancer. METHODS: Data from all patients undergoing pneumonectomy for primary lung cancer at 2 large thoracic surgical centres between 2012 and 2018 were analysed. Multivariable logistic and Cox regression analyses were used to identify risk factors associated with 90-day and 1-year mortality and reduced long-term survival, respectively. RESULTS: The study included 256 patients. The mean age was 65.2 (standard deviation 9.4) years. In-hospital, 90-day and 1-year mortality were 6.3% (n = 16), 9.8% (n = 25) and 28.1% (n = 72), respectively. The median follow-up time was 31.5 months (interquartile range 9–58 months). Patients who underwent neoadjuvant therapy had a significantly increased risk of 90-day [odds ratio 6.451, 95% confidence interval (CI) 1.867–22.291, P = 0.003] and 1-year mortality (odds ratio 2.454, 95% CI 1.079–7.185, P = 0.044). Higher Performance Status score was associated with higher 1-year mortality (odds ratio 2.055, 95% CI 1.248–3.386, P = 0.005) and reduced overall survival (hazard ratio 1.449, 95% CI 1.086–1.934, P = 0.012). Advanced (stage III/IV) disease was associated with reduced overall survival (hazard ratio 1.433, 95% CI 1.019–2.016, P = 0.039). Validation of a pneumonectomy-specific risk model demonstrated inadequate model performance (area under the curve 0.54). CONCLUSIONS: Pneumonectomy remains associated with a high rate of perioperative mortality. Neoadjuvant chemoradiotherapy, Performance Status score and advanced disease emerged as the key variables associated with adverse outcomes after pneumonectomy in our cohort. Oxford University Press 2021-12-06 /pmc/articles/PMC9159428/ /pubmed/34871415 http://dx.doi.org/10.1093/icvts/ivab340 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Thoracic Brunswicker, Annemarie Taylor, Marcus Grant, Stuart W Abah, Udo Smith, Matthew Shackcloth, Michael Granato, Felice Shah, Rajesh Rammohan, Kandadai Pneumonectomy for primary lung cancer: contemporary outcomes, risk factors and model validation |
title | Pneumonectomy for primary lung cancer: contemporary outcomes, risk factors and model validation |
title_full | Pneumonectomy for primary lung cancer: contemporary outcomes, risk factors and model validation |
title_fullStr | Pneumonectomy for primary lung cancer: contemporary outcomes, risk factors and model validation |
title_full_unstemmed | Pneumonectomy for primary lung cancer: contemporary outcomes, risk factors and model validation |
title_short | Pneumonectomy for primary lung cancer: contemporary outcomes, risk factors and model validation |
title_sort | pneumonectomy for primary lung cancer: contemporary outcomes, risk factors and model validation |
topic | Thoracic |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9159428/ https://www.ncbi.nlm.nih.gov/pubmed/34871415 http://dx.doi.org/10.1093/icvts/ivab340 |
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