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  P3.15 - Treatment in the Real World - Support, Survivorship, Systems Research (Not CME Accredited Session) (ID 981)

  • Event: WCLC 2018
  • Type: Poster Viewing in the Exhibit Hall
  • Track:
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall

  • 27729

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    P3.15-22 - Validation of Eurolung Risk Models in a Japanese Population: A Retrospective Single-Center Analysis of 612 Cases (ID 13280)

    12:00 - 13:30  |  Author(s): Takashi Kanou
    • Abstract
    • Slides

    Background
    

    The analysis of risk-adjusted outcome is beneficial for quality assessment in surgery as well as preoperative risk stratification. Eurolung risk models are recently reported, large population-based prediction tools of cardiopulmonary morbidity and mortality in patients who underwent anatomic lung resection. This study is aimed to evaluate validity of the models in a Japanese population.

    a9ded1e5ce5d75814730bb4caaf49419 Method
    

    From 2007 to 2014, 637 anatomic lung resections were performed in our institution. Patients who had induction therapy (n=23) and with missing data (n=2) were excluded from the analysis, and requisite variables (age, sex, body mass index, predicted postoperative forced expiratory volume in 1 s, coronary artery disease, cerebrovascular disease, chronic kidney disease, thoracotomy approach, extended resections, operation of pneumonectomy) were examined. Cardiopulmonary morbidity and 30-day mortality rates were estimated by Eurolung risk models according to the formula for computation (Brunelli A, et al. European risk models for morbidity (EuroLung1) and mortality (EuroLung2) to predict outcome following anatomic lung resections: an analysis from the European Society of Thoracic Surgeons database. Eur J Cardiothorac Surg, 2017; 51: 490-497). Aggregated Eurolung risk scores were also calculated, and patients with similar risk were classified into plural groups. These results were compared with observed outcomes. In addition, we analyzed long term outcomes of the groups using the Kaplan-Meier method.

    4c3880bb027f159e801041b1021e88e8 Result
    

    Surgical procedures included 9 pneumonectomies, 15 bilobectomies, 483 lobectomies, and 105 segmentectomies. Cardiopulmonary complications of any grade were occurred in 137 cases; this rate was lower than predicted by Eurolung1 (22.4% vs. 28.4%). Within 30 days after operation, 4 fatal cases were experienced, which was significantly lower than expected by Eurolung2 (0.7% vs. 6.9%). Morbidity rate was clearly stratified by Eurolung1 aggregate score as 0% (n=0, score 0-1), 14.7% (n=11, score 2-4), 18.6% (n=30, score 5-7), 21.3% (n=46, score 8-11), 34.5% (n=49, score 12-16), and 33.3% (n=1, score 17-19). Stratification of mortality rate by Eurolung2 aggregate score also developed apparent trend, although the observed number of death was quite small: 0% (score 0-3), 0% (score 4-6), 1.2% (score 7-8), 1.5% (score 9-11), 4.8% (score 12-14), and 0% (score 15-17). The Higher (8-19) Eurolung1 aggregate score group showed poor 5-year overall survival compared with the lower (0-7) score group (72.3% vs. 90.4%, P<0.01).

    8eea62084ca7e541d918e823422bd82e Conclusion
    

    Eurolung risk models did not completely match with the morbidity and mortality in our institution. On the other hand, Eurolung1 aggregate score was useful to predict not only morbidity, but also long term outcomes.

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