The Preoperative Composite Physiologic Index May Predict Mortality in Lung Cancer Patients with Combined Pulmonary Fibrosis and Emphysema

Abstract

Background: It remains unclear whether the preoperative pulmonary function parameters and prognostic indices that are indicative of nutritional and immunological status are associated with prognosis in lung cancer patients with combined pulmonary fibrosis and emphysema (CPFE) who have undergone surgery. Objective: The aim of this study is to identify prognostic determinants in these patients. Methods: The medical records of all patients with lung cancer associated with CPFE who had undergone surgery at Shinshu University Hospital were retrospectively reviewed to obtain clinical data, including the results of preoperative pulmonary function tests and laboratory examinations, chest high-resolution computed tomography (HRCT), and survival. Results: Univariate Cox proportional hazards regression analysis showed that a high pathological stage of the lung cancer, a higher preoperative serum carcinoembryonic antigen level, and a higher preoperative composite physiologic index (CPI) were associated with a high risk of death. Multivariate analysis showed that a high pathological stage of the lung cancer (HR: 1.579; p = 0.0305) and a higher preoperative CPI (HR: 1.034; p = 0.0174) were independently associated with a high risk of death. In contrast, the severity of fibrosis or emphysema on chest HRCT, the individual pulmonary function parameters, the prognostic nutritional index, the neutrophil-to-lymphocyte ratio, and the platelet-to-lymphocyte ratio were not associated with prognosis. In the Kaplan-Meier analysis, the log-rank test showed significant differences in survival between the high-CPI and the low-CPI group (p = 0.0234). Conclusion: The preoperative CPI may predict mortality and provide more powerful prognostic information than individual pulmonary function parameters in lung cancer patients with CPFE who have undergone surgery.

Usefulness of quantitative computed tomography analysis using a commercially available software program through its simple and automatic procedures in evaluation of emphysema and pulmonary fibrosis

“…We investigated correlations between the quantitative assessment performed by the software program and the visual assessment based on the previous reports [19][20][21][22][23][24] in patients with COPD and IPF. We determined sensitivity and specificity of LAV and HAV to detect emphysema and pulmonary fibrosis, respectively, which were detected in the visual assessment.…”

“…In order to investigate whether the LAV% and HAV% could reflect the extent of emphysema and pulmonary fibrosis, respectively, we assessed the validity of the quantitative assessment performed by the software program as compared with a visual assessment using an established method. The visual assessment was performed based on the method of previous reports [19][20][21][22][23][24]. Emphysema was scored visually in the bilateral upper, middle and lower lung fields according to the methods of Goddard et al [25].…”

“…All patients underwent spirometry and measurements of the diffusion capacity of lung for carbon monoxide (DLco) , DLco corrected for alveolar volume (DLco/VA), a global measure of ventilation heterogeneity (the slope of phase III of the single breath nitrogen washout test [delta N 2 ]), the functional residual capacity (FRC), the total lung capacity (TLC) and the residual volume (RV) by using a pulmonary function testing system (Chestac-8900 ® ; CHEST Co., Ltd., Tokyo, Japan), as previously described [19][20][21][22][23][24]. We also evaluated the composite physiologic index (CPI) which was calculated based on pulmonary function parameters [24].…”

Dissecting Survival Pathways in Lung Cancer, Fibrosis and Emphysema: “The Four Horses of the Apocalypse”

“…The study by Ueno et al [11] exhibited several important attributes: (1) it was the first study in the field that tested the usefulness of 8 different prognostic indicators, including molecular, histological, physiological, radiological and cellular, in predicting mortality in a moderately sized cohort of patients with CPFE, (2) while it was anticipated that the pathological stage of lung cancer could be predictive of mortality; however, the effectiveness of a previously validated cut-off threshold of a clinical-physiological indicator to segregate patients with significantly different outcomes in a completely different cohort of CPFE patients is of pivotal importance. The latter highlights the fulfilment of the, so far, unmet need of a true biomarker in everyday clinical practice: non-interventional with ease of application and significant reproducibility; (3) finally, the authors addressed a major challenge for chest physicians: the validation of a clinical biomarker for the early identification of a group of patients presenting with a highly unpredictable clinical course and considerable mortality that could benefit from timely application of surgical interventions, both diagnostic and therapeutic.…”

“…In a recent issue of Respiration, Ueno et al [11] investigated the potential usefulness of several preoperative biomarkers in predicting post-operative mortality in a cohort of patients with lung cancer and CPFE. The authors retrospectively reviewed 1,345 cases of patients that underwent lung surgery for primary lung cancer in a university hospital of Japan during a study period of 14 years.…”