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. 2022 Jun 1;34(6):1054-1061.
doi: 10.1093/icvts/ivab340.

Pneumonectomy for primary lung cancer: contemporary outcomes, risk factors and model validation

Annemarie Brunswicker  1 , Marcus Taylor  1 , Stuart W Grant  2 , Udo Abah  3 , Matthew Smith  3 , Michael Shackcloth  3 , Felice Granato  1 , Rajesh Shah  1 , Kandadai Rammohan  1 ; North West Thoracic Surgery Collaborative (NWTSC)†
Collaborators, Affiliations

Pneumonectomy for primary lung cancer: contemporary outcomes, risk factors and model validation

Annemarie Brunswicker et al. Interact Cardiovasc Thorac Surg. .

Abstract

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.

Keywords: 90-Day mortality; Non-small-cell lung cancer; Pneumonectomy; Risk model.

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Figures

Figure 1:
Figure 1:
Kaplan–Meier curve for survival after pneumonectomy.
Figure 2:
Figure 2:
Calibration plot for the Safi model for predicting in-hospital mortality. The solid line is a flexible calibration curve fitted with restricted cubic splines. The triangle points are a binned calibration plot, with mean observed and expected risks calculated in 10 equally sized groups. The dotted line represents perfect calibration.
None
See this image and copyright information in PMC

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