Risk Stratification for Lung Cancer Patients

Abstract

A comprehensive review of relevant clinical literature on evidence-based recommendations and existing prediction models specific to lung cancer surgery was undertaken. Preoperative risk assessment parameters such as pulmonary function tests (PFT), cardiopulmonary exercise testing (CPET), Brunelli models, Thoracoscore and frailty were analyzed for predicting postoperative risk of complications.When assessing fitness for surgery, the primarily used PFT parameters such as predictive postoperative forced expiratory volume in one second (FEV1) and diffusion capacity for carbon monoxide (DLCO ) showed conflicting evidence in determining a positive correlation with postoperative mortality. CPET variables predicted higher complication risk when VO2peak < 10ml/kg/min, AT < 11ml/kg/min and ventilation/carbon dioxide production (VE/VCO2) was in range of 34-40. While a cardiac risk index like the Thoracic Revised Cardiac Risk Index (ThRCRI) predicted major cardiovascular compromise, a thoracic risk index like Thoracoscore proved imprecise. Lastly, frailty is used to risk stratify patients in clinical practice but a recognized validated model specific to thoracic surgery is non-existent.When considering patients for lung cancer surgery, some dilemma exists regarding the accuracy of clinical prediction models and their external validation. There is a pressing need for the development of a consolidated clinically robust risk stratification model to predict complications after thoracic resections.

Exploration of the causality of frailty index on psoriasis: A Mendelian randomization study

“…6 With the aging of population, the FI has been paid more and more attention in clinical application. 4 Nowadays, the FI is widely used in prediction of risk of death in cardiovascular patients, 7 evaluation of candidates for organ transplantation, 8 preoperative evaluation of tumor surgery, 9 prediction of adverse outcomes of head and neck reconstruction and so on. 10 At the same time, numerous studies reveal the causal relationship between FI and diseases, serum indicators, and lifestyle through MR analysis.…”

Risk stratification of postoperative pulmonary complications in elderly patients undergoing lung cancer resection: a propensity score-matched study

“…With improved surgical techniques, anesthesia, and perioperative care, enhanced recovery after surgery (ERAS) protocols have shown improved outcomes in thoracic surgery ( 8 ). However, PPCs are still common among patients undergoing lung cancer surgery, with reported incidence rates ranging from 10% to 50%, depending on the definition of PPCs, the assessment of clinical criteria, and the surgical procedure ( 9 ). The most reported pulmonary complications include atelectasis, pneumonia, and acute respiratory failure requiring prolonged mechanical ventilation or re-intubation in within 48 hours ( 10 ).…”