Preoperative renal dysfunction and long-term survival after surgery for non–small cell lung cancer,The Journal of Thoracic and Cardiovascular Surgery

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Preoperative renal dysfunction and long-term survival after surgery for non–small cell lung cancer
The Journal of Thoracic and Cardiovascular Surgery ( IF 4.9 ) Pub Date : 2021-09-10 , DOI: 10.1016/j.jtcvs.2021.09.008
Tomohito Saito ₁ , Tomohiro Murakawa ₁ , Yasushi Shintani ₂ , Jiro Okami ₃ , Etsuo Miyaoka ₄ , Ichiro Yoshino ₅ , Hiroshi Date ₆ ,

Affiliation

Objective

To investigate the association of preoperative renal dysfunction and long-term outcomes following lung cancer surgery.

Methods

Using the Japanese Lung Cancer Registry data, we retrospectively examined 16,377 patients who underwent surgery for non–small cell lung cancer during 2010. Patients' renal function status was categorized as follows: serum creatinine <1.5 mg/dL (control, n = 16,169), serum creatinine ≥1.5 mg/dL with no dialysis (nondialysis-dependent chronic kidney disease, n = 113), and dialysis-dependent end-stage renal disease (n = 95). The association of patients' characteristics with overall survival was evaluated using multivariate Cox proportional hazard model.

Results

The 5-year overall survival rates in patients with dialysis-dependent end-stage renal disease and with nondialysis-dependent chronic kidney disease were significantly worse than that in the control group (52.9% and 57.5% vs 78.0%; P < .001 for both comparisons), but were comparable to the reported 5-year overall survival rates in the natural history of end-stage renal disease (∼60%) and moderate to severe chronic kidney disease (∼50%). Cancer causes not related to lung cancer accounted for 62.2% of deaths in dialysis-dependent end-stage renal disease, which was more frequent than that in the control group (P = .002). Dialysis-dependent end-stage renal disease and nondialysis-dependent chronic kidney disease were independent risk factors for overall survival after lung cancer surgery (hazard ratio, 2.05 [P < .001] and hazard ratio, 2.04 [P = .001], respectively).

Conclusions

Preoperative renal dysfunction may be adversely associated with overall survival after lung cancer surgery. Our findings could aid patients to set proper expectation of the risks and benefits about surgery for lung cancer.

中文翻译：

非小细胞肺癌术前肾功能不全与术后长期生存

客观的

调查肺癌手术后术前肾功能不全与长期预后的关系。

方法

使用日本肺癌登记数据，我们回顾性检查了 2010 年接受非小细胞肺癌手术的 16,377 名患者。患者的肾功能状态分类如下：血清肌酐 <1.5 mg/dL（对照，n = 16,169），血清肌酐≥1.5 mg/dL，无透析（非透析依赖性慢性肾病，n = 113）和透析依赖性终末期肾病（n = 95）。使用多变量 Cox 比例风险模型评估患者特征与总生存期的关联。

结果

依赖透析的终末期肾病和非透析依赖的慢性肾病患者的 5 年总生存率显着低于对照组（52.9% 和 57.5% vs 78.0%；P < .001 for两个比较），但与终末期肾病（~60%）和中度至重度慢性肾病（~50%）自然史中报告的 5 年总生存率相当。与肺癌无关的癌症原因占透析依赖性终末期肾病死亡的 62.2%，高于对照组（P = .002)。依赖透析的终末期肾病和非依赖透析的慢性肾病是肺癌手术后总生存期的独立危险因素（风险比分别为 2.05 [ P < .001] 和风险比为 2.04 [ P = .001] ）。