Impact of diffusing lung capacity before and after neoadjuvant concurrent chemoradiation on postoperative pulmonary complications among patients with stage IIIA/N2 non-small-cell lung cancer

Sumin Shin, Yong Soo Choi, Jae Jun Jung, Yunjoo Im, Sun Hye Shin, Danbee Kang, Jong Ho Cho, Hong Kwan Kim, Jhingook Kim, Jae Ill Zo, Young Mog Shim, Keunchil Park, Myung Ju Ahn, Yong Chan Ahn, Genehee Lee, Juhee Cho, Ho Yun Lee, Hye Yun Park

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7 Scopus citations

Abstract

Background and objective: This study aims to evaluate the impact of diffusing capacity of the lung for carbon monoxide (DLco) before and after neoadjuvant concurrent chemoradiotherapy (CCRT) on postoperative pulmonary complication (PPC) among stage IIIA/N2 non-small-cell lung cancer (NSCLC) patients. Methods: We retrospectively studied 324 patients with stage IIIA/N2 NSCLC between 2009 and 2016. Patients were classified into 4 groups according to DLco before and after neoadjuvant CCRT; normal-to-normal (NN), normal-to-low (NL), low-to-low (LL), and low-to-very low (LVL). Low DLco and very low DLco were defined as DLco < 80% predicted and DLco < 60% predicted, respectively. Results: On average, DLco was decreased by 12.3% (±10.5) after CCRT. In multivariable-adjusted analyses, the incidence rate ratio (IRR) for any PPC comparing patients with low DLco to those with normal DLco before CCRT was 2.14 (95% confidence interval (CI) = 1.36-3.36). Moreover, the IRR for any PPC was 3.78 (95% CI = 1.68-8.49) in LVL group compared to NN group. The significant change of DLco after neoadjuvant CCRT had an additional impact on PPC, particularly after bilobectomy or pneumonectomy with low baseline DLco. Conclusions: The DLco before CCRT was significantly associated with risk of PPC, and repeated test of DLco after CCRT would be helpful for risk assessment, particularly in patients with low DLco before neoadjuvant CCRT.

Original languageEnglish
Article number13
JournalRespiratory Research
Volume21
Issue number1
DOIs
StatePublished - 10 Jan 2020

Keywords

  • Dlco
  • Non-small cell lung Cancer
  • Outcomes
  • Postoperative complication

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