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. 2022 Aug;164(2):389-397.e7.
doi: 10.1016/j.jtcvs.2021.12.030. Epub 2021 Dec 23.

Postinduction therapy pulmonary function retesting is necessary before surgical resection for non-small cell lung cancer

James G Connolly  1 , Megan Fiasconaro  2 , Kay See Tan  2 , Michael A Cirelli Jr  1 , Gregory D Jones  1 , Raul Caso  1 , Daniel E Mansour  1 , Joseph Dycoco  1 , Jae Seong No  1 , Daniela Molena  3 , James M Isbell  3 , Bernard J Park  3 , Matthew J Bott  3 , David R Jones  3 , Gaetano Rocco  4
Affiliations

Postinduction therapy pulmonary function retesting is necessary before surgical resection for non-small cell lung cancer

James G Connolly et al. J Thorac Cardiovasc Surg. 2022 Aug.

Abstract

Objective: Pretreatment-predicted postoperative diffusing capacity of the lung for carbon monoxide (DLCO) has been associated with operative mortality in patients who receive induction therapy for resectable non-small cell lung cancer (NSCLC). It is unknown whether a reduction in pulmonary function after induction therapy and before surgery affects the risk of morbidity or mortality. We sought to determine the relationship between induction therapy and perioperative outcomes as a function of postinduction pulmonary status in patients who underwent surgical resection for NSCLC.

Methods: We retrospectively reviewed data for 1001 patients with pathologic stage I, II, or III NSCLC who received induction therapy before lung resection. Pulmonary function was defined according to American College of Surgeons Oncology Group major criteria: DLCO ≥50% = normal; DLCO <50% = impaired. Patients were categorized into 5 subgroups according to combined pre- and postinduction DLCO status: normal-normal, normal-impaired, impaired-normal, impaired-impaired, and preinduction only (without postinduction pulmonary function test measurements). Multivariable logistic regression was used to quantify the relationship between DLCO categories and dichotomous end points.

Results: In multivariable analysis, normal-impaired DLCO status was associated with an increased risk of respiratory complications (odds ratio, 2.29 [95% CI, 1.12-4.49]; P = .02) and in-hospital complications (odds ratio, 2.83 [95% CI, 1.55-5.26]; P < .001). Type of neoadjuvant therapy was not associated with an increased risk of complications, compared with conventional chemotherapy.

Conclusions: Reduced postinduction DLCO might predict perioperative outcomes. The use of repeat pulmonary function testing might identify patients at higher risk of morbidity or mortality.

Keywords: DLCO; diffusing capacity of the lung for carbon monoxide; non–small cell lung cancer; pulmonary function testing.

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Conflict of interest statement

COI statement: Daniela Molena serves as a consultant for Johnson & Johnson, Urogen, and Boston Scientific. James M. Isbell has equity in LumaCyte LLC, serves as an uncompensated consultant to Roche-Genentech, and has received institutional research support from Grail and Guardant Health. Bernard J. Park has served as a proctor for Intuitive Surgical and consultant for COTA. Matthew J. Bott serves as a consultant for AstraZeneca. David R. Jones serves as a consultant for Merck and AstraZeneca. Gaetano Rocco has a financial relationship with Scanlan and serves as a consultant for AstraZeneca. All other authors have no potential conflicts to disclose.

Figures

Figure 1.
Figure 1.
CONSORT diagram. ICI, immune checkpoint inhibitor; NSCLC, non-small cell lung cancer; PFT, pulmonary function test.
Figure 2.
Figure 2.
Graphical abstract. Treatment decision tree according to pre- and post-induction PFTs. 575 patients with pathologic stage I-III NSCLC who received induction therapy before lung resection and pre- and post-induction pulmonary function testing were included. Patients were categorized into four subgroups according to ACOSOG major criteria: normal-normal, normal-impaired, impaired-normal, and impaired-impaired. Changes from pre- to postinduction pulmonary function status were associated with differences in perioperative outcomes; therefore, repeat pulmonary function testing should be performed after induction therapy. If the patient’s status changed from normal to impaired the authors recommend re-evaluation, pre-operative pulmonary optimization and even sublobar resection, when appropriate, to reduce the perioperative risk. Implications: Changes in DLco from pre- to postinduction pulmonary function status may predict perioperative outcomes; therefore, repeat pulmonary function testing should be performed after induction therapy to assess patient operability. If the patient’s status changes from normal to impaired, based on ACOSOG major criteria, re-evaluation, pulmonary optimization and even sublobar resection, in the appropriate context, should be assessed. PFT, Pulmonary function testing; DLco, Diffusing capacity of the lung for carbon monoxide; NSCLC, Non-small cell lung cancer; SBRT, Stereotactic body radiation therapy
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Comment in

  • Commentary: Dogma and data.
    Klipsch EC, Denlinger CE. Klipsch EC, et al. J Thorac Cardiovasc Surg. 2022 Aug;164(2):409-410. doi: 10.1016/j.jtcvs.2021.09.040. Epub 2021 Sep 29. J Thorac Cardiovasc Surg. 2022. PMID: 34635314 No abstract available.
  • Commentary: Dum spiro spero.
    Freeman RK. Freeman RK. J Thorac Cardiovasc Surg. 2022 Aug;164(2):398-399. doi: 10.1016/j.jtcvs.2022.01.031. Epub 2022 Jan 31. J Thorac Cardiovasc Surg. 2022. PMID: 35221025 No abstract available.

References

    1. Van Meerbeeck JP, Kramer GW, Van Schil PE, Legrand C, Smit EF, Schramel F, et al. Randomized controlled trial of resection versus radiotherapy after induction chemotherapy in stage IIIA-N2 non–small-cell lung cancer. J Natl Cancer I. 2007;99(6):442–50. - PubMed
    1. International Adjuvant Lung Cancer Trial Collaborative Group. Cisplatin-based adjuvant chemotherapy in patients with completely resected non–small-cell lung cancer. N Engl J Med. 2004;350(4):351–60. - PubMed
    1. Waller D, Peake MD, Stephens RJ, Gower NH, Milroy R, Parmar MK, et al. Chemotherapy for patients with non-small cell lung cancer: the surgical setting of the Big Lung Trial. Eur J Cardiothorac. 2004;26(1):173–82. - PubMed
    1. Pisters KM, Ginsberg RJ, Giroux DJ, Putnam JB Jr, Kris MG, Johnson DH, et al. Induction chemotherapy before surgery for early-stage lung cancer: a novel approach. J Thorac Cardiovasc Surg. 2000;119(3):429–39. - PubMed
    1. Forde PM, Chaft JE, Smith KN, Anagnostou V, Cottrell TR, Hellmann MD, et al. Neoadjuvant PD-1 blockade in resectable lung cancer. N Engl J Med. 2018;378(21):1976–86. - PMC - PubMed

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