Thoracic: Lung Cancer
Preoperative renal dysfunction and long-term survival after surgery for non–small cell lung cancer

https://doi.org/10.1016/j.jtcvs.2021.09.008Get rights and content

Abstract

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.

Section snippets

Registry

The Japanese Joint Committee of Lung Cancer Registry (JJCLCR) conducted a nationwide retrospective registry study of patients who underwent surgery for lung cancer during 2010. The data registration was conducted through an Internet-based system between January 1, 2016, and October 31, 2016. The detailed information on the collected variables and data examination is described in a previous report.19 Information on lung cancer was registered compliant with the seventh edition of the Japan Lung

Results

The clinical and pathological characteristics of the study population according to the renal function status are summarized in Table 1. Both the DD-ESRD and NDD-CKD groups had a higher proportion of male patients and patients with European Cooperative Oncology Group performance status ≥1, a lower percent vital capacity, a lower forced expiratory volume in 1 second, a lower diffusing capacity for carbon monoxide, hypertension, diabetes mellitus, cardiovascular disease, cerebrovascular disease,

Discussion

The present study revealed the adverse association of preoperative renal dysfunction with OS after surgery for NSCLC (Figure 3 and Video 1). As detailed information on long-term outcome of surgery for NSCLC in patients with ESRD and CKD is sparse, our findings would be able to assist in the clinical counseling of NSCLC patients with renal dysfunction to set proper expectations of the risks and benefits of surgical treatment.

. Summary of this study. Through retrospective study on 16,377 patients

Conclusions

We have shown the adverse association of preoperative ESRD/CKD with OS after surgery for NSCLC and the potential survival benefit of surgery for NSCLC in selected patients with ESRD/CKD. Our findings could aid patients with NSCLC and ESRD/CKD in treatment planning. Further investigation is necessary to identify the optimal treatment strategy that can manage both oncologic and nononcologic problems in patients with NSCLC and ESRD or CKD. A complete list of additional references is provided in

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    • ∗

    A complete list of the working group members of the Japanese Joint Committee of Lung Cancer Registry is provided in Appendix E1.

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