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.

中文翻译：

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新辅助同步放化疗前后弥散肺活量对ⅢA/N2期非小细胞肺癌患者术后肺部并发症的影响


背景与目的本研究旨在评价IIIA/N2期非小细胞肺癌新辅助同步放化疗（CCRT）前后肺一氧化碳（DLco）弥散能力对术后肺部并发症（PPC）的影响。 （非小细胞肺癌）患者。方法我们回顾性研究了2009年至2016年间324例IIIA/N2期NSCLC患者。根据新辅助CCRT前后的DLco将患者分为4组；正常到正常 (NN)、正常到低 (NL)、低到低 (LL) 和低到极低 (LVL)。低 DLco 和极低 DLco 分别定义为 DLco < 预测值的 80% 和 DLco < 预测值的 60%。结果 CCRT 后 DLco 平均下降 12.3% (±10.5)。在多变量调整分析中，CCRT 前将低 DLco 患者与 DLco 正常患者进行比较的任何 PPC 的发生率比 (IRR) 均为 2.14（95% 置信区间 (CI) = 1.36-3.36）。此外，与 NN 组相比，LVL 组中任何 PPC 的 IRR 均为 3.78 (95% CI = 1.68-8.49)。新辅助 CCRT 后 DLco 的显着变化对 PPC 产生额外影响，特别是在 DLco 基线较低的双肺叶切除或全肺切除术后。结论 CCRT前DLco与PPC风险显着相关，CCRT后重复检测DLco有助于风险评估，特别是新辅助CCRT前DLco低的患者。