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Comparative Study
. 2016 Mar;151(3):697-705.e1.
doi: 10.1016/j.jtcvs.2015.08.058. Epub 2015 Aug 24.

The National Surgical Quality Improvement Program risk calculator does not adequately stratify risk for patients with clinical stage I non-small cell lung cancer

Pamela Samson  1 , Clifford G Robinson  2 , Jeffrey Bradley  2 , Audrey Lee  1 , Stephen Broderick  3 , Daniel Kreisel  1 , A Sasha Krupnick  1 , G Alexander Patterson  1 , Varun Puri  1 , Bryan F Meyers  1 , Traves Crabtree  4
Affiliations
Comparative Study

The National Surgical Quality Improvement Program risk calculator does not adequately stratify risk for patients with clinical stage I non-small cell lung cancer

Pamela Samson et al. J Thorac Cardiovasc Surg. 2016 Mar.

Abstract

Objective: The study objective was to validate the National Surgical Quality Improvement Program (NSQIP) Risk Calculator in stratifying risk estimates for patients who received surgery or stereotactic body radiation therapy for clinical stage I non-small cell lung cancer.

Methods: A retrospective analysis of patients with clinical stage I non-small cell lung cancer undergoing surgery (N = 279) or stereotactic body radiation therapy (N = 206) from 2009 to 2012 was performed. NSQIP complication risk estimates were calculated for both surgical and stereotactic body radiation therapy cases using the NSQIP Surgical Risk Calculator. NSQIP complication risk estimates were compared as continuous variables and by quartile ranges.

Results: Compared with patients undergoing video-assisted thoracoscopic surgery wedge resection, patients receiving stereotactic body radiation therapy were older, had larger tumors, had lower forced expiratory volume (FEV1) in 1 second and diffusing capacity of the lungs (DLCO) for carbon monoxide values, had higher American Society of Anesthesiologists scores, had higher rates of dyspnea, and had higher NSQIP serious complication risk estimates (all P < .05). Compared with patients undergoing video-assisted thoracoscopic surgery lobectomy, patients receiving stereotactic body radiation therapy had similar disparities, along with higher Adult Comorbidity Evaluation-27 (ACE) scores comorbidity scores, higher rates of cardiac comorbidities, and worse functional status (all P < .05). Variables associated with receiving stereotactic body radiation therapy treatment, rather than wedge resection, included increasing age, higher Adult Comorbidity Evaluation (ACE)-27 comorbidity score, dyspnea status, and decreasing FEV1 in 1 second and DLCO for carbon monoxide, but NSQIP serious complication risk score. In addition, surgical patients' actual serious complication rate (16.6% vs 8.8%) and pneumonia rate (6.0% vs 3.2%) were significantly higher than the NSQIP risk calculator predicted (all P < .05).

Conclusions: The National Surgical Quality Improvement Program risk calculator does not effectively classify or stratify risk in patients with stage I non-small cell lung cancer. Continued efforts are needed to assess risk in this population and develop more tailored treatment decision aids.

Keywords: NSQIP; SBRT; lobectomy; lung cancer.

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Conflict of interest statement

Conflict of Interest Statement

Authors have nothing to disclose with regard to commercial support.

Figures

FIGURE 1
FIGURE 1
A, Frequency of VATS wedge resection surgical cases (blue) and SBRT cases (green) by quartile of NSQIP serious complication risk estimates. Quartiles were generated from the entire range of NSQIP serious complication risk estimate scores for both the VATS wedge surgical cases and the SBRT cases (as if they were being considered for a VATS wedge resection). The difference between the distributions of these quartiles by treatment type was significant (P < .001). B, Frequency of VATS lobectomy surgical cases (blue) and SBRT (green) by quartile of NSQIP serious complication risk estimate. Quartiles were generated from the entire range of NSQIP serious complication risk estimate scores for both the VATS lobectomy cases and the SBRT cases (as if they were being considered for a VATS lobectomy). The difference between the distributions of these quartiles by treatment type was significant (P < .001). NSQIP, National Surgical Quality Improvement Program; NSCLC, non–small cell lung cancer; VATS, video-assisted thoracoscopic surgery; SBRT, stereotactic body radiation therapy.
FIGURE 2
FIGURE 2
A, Frequency plot of VATS wedge resection (blue) and SBRT (green) by NSQIP serious complication risk estimate. Despite a significant difference in the mean risk estimate values on univariate analysis, the plot demonstrates substantial overlap for VATS wedge resection and SBRT cases. B, Frequency plot of surgical resection (blue) and SBRT (green) by NSQIP serious complication risk estimate for VATS lobectomy cases and SBRT cases (had they received a VATS lobectomy). Despite a significant difference in the mean risk estimate values on univariate analysis, the frequency plot demonstrates substantial overlap for VATS lobectomy and SBRT cases. NSQIP, National Surgical Quality Improvement Program; VATS, video-assisted thoracoscopic surgery; SBRT, stereotactic body radiation therapy.
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Comment in

  • Risk calculators are useful but...
    Wang X, Berry MF. Wang X, et al. J Thorac Cardiovasc Surg. 2016 Mar;151(3):706-707. doi: 10.1016/j.jtcvs.2015.09.058. Epub 2015 Sep 24. J Thorac Cardiovasc Surg. 2016. PMID: 26896356 Free PMC article. No abstract available.

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