Study on influencing factors and predictive model construction of cardiopulmonary complication after thoracoscopic surgery in stage I-II non-small cell lung cancer

doi:10.11958/20250702

Abstract

Abstract:

Objective To construct a multivariable prediction model for assessing the risk of cardiopulmonary complication after thoracoscopic lobectomy in patients with stage Ⅰ-Ⅱ non-small cell lung cancer (NSCLC). Methods Clinical data of 600 patients with stage Ⅰ-Ⅱ NSCLC who underwent thoracoscopic lobectomy were retrospectively analyzed. Patients were divided into the complication group (84 cases) and the non-complication group (516 cases) based on the occurrence of postoperative complication within 7 days, including atelectasis, pulmonary embolism, respiratory failure, chylothorax, massive pleural effusion, hypoxemia and atrial fibrillation. Demographic characteristics, preoperative pulmonary function assessment, pathological features and perioperative indicators were collected. Multivariate Logistic regression analysis was used to identify independent risk factors influencing postoperative cardiopulmonary complication in patients and construct a predictive model. Internal validation was performed using the Bootstrap resampling method (1 000 iterations) to evaluate the discrimination, calibration and clinical decision-making value of the model. Results Multivariate Logistic regression analysis identified the following independent risk factors of postoperative cardiopulmonary complication, including age (OR=1.832, 95%CI: 1.537-2.183), history of chronic obstructive pulmonary disease (COPD) (OR=6.782, 95%CI: 2.685-17.130), Karnofsky performance status (KPS) score (OR=0.926, 95%CI: 0.888-0.965), the percentage of forced expiratory volume in the first second to the predictive value (FEV1%pred) (OR=0.906, 95%CI: 0.845-0.972), the percentage of diffusing capacity for carbon monoxide to the expected value (DLCO%pred) (OR=0.901, 95%CI: 0.832-0.975), intraoperative blood loss (OR=1.025, 95%CI: 1.014-1.036) and one-lung ventilation time (OR=1.057, 95%CI: 1.034-1.080). The area under the curve (AUC) of the combined diagnosis was 0.977 (95%CI: 0.965-0.989), with 96.4% sensitivity and 87.6% specificity. The Hosmer-Lemeshow test indicated excellent calibration (χ2=1.285, P=0.994). Decision curve analysis demonstrated significant clinical net benefit when the risk threshold probability ranged between 20% and 98%. Conclusion The multivariable prediction model for cardiopulmonary complication after thoracoscopic lobectomy in stage Ⅰ-Ⅱ NSCLC patients exhibits strong predictive performance.

Key words: cavcinoma, non-small-cell lung, risk factors, thoracoscopy, cardiopulmonary complications, predictive model

CLC Number:

R734.2

Figures/Tables 7

References 24

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组别		n		性别（男/女）			年龄/岁			BMI分级							吸烟史			COPD
组别		n		性别（男/女）			年龄/岁			正常			超重	肥胖			吸烟史			COPD
无并发症组		516		260/256			59.37±4.59			300（58.1）			160（31.0）	56（10.9）			355（68.8）			85（16.5）
并发症组		84		40/44			67.14±3.25			43（51.2）			27（32.1）	14（16.7）			65（77.4）			28（33.3）
χ²或t				0.221			19.030^＊＊			2.733							2.534			13.434^＊＊
组别			冠心病			高血压		2型糖尿病				术前KPS评分/分				DLCO%pred			病变侧别/右肺		低分化
无并发症组			30（5.8）			180（34.9）		60（11.6）				89.17±9.11				89.31±6.02			260（50.4）		120（23.3）
并发症组			12（14.3）			40（47.6）		20（23.8）				84.76±12.07				87.31±4.60			48（57.1）		24（28.6）
χ²或t			7.964^＊＊			5.045^＊		9.277^＊＊				3.202^＊＊				3.528^＊＊			1.320		1.119
组别	TNM分期 Ⅱ期				腺癌				手术时间/ min		术中失血量/ mL				单肺通气时间/ min			术中最低 SpO₂/%				FEV1%pred
无并发症组	220（42.6）				385（74.6）				165.71±20.78		161.46±52.32				99.53±18.58			91.86±6.18				81.67±7.04
并发症组	40（47.6）				61（72.6）				176.71±25.47		211.14±47.11				123.75±24.78			88.13±6.54				76.38±5.61
χ²或t	0.731				0.150				4.350^＊＊		8.821^＊＊				18.668^＊＊			6.094^＊＊				7.664^＊＊

组别		n		性别（男/女）			年龄/岁			BMI分级							吸烟史			COPD
组别		n		性别（男/女）			年龄/岁			正常			超重	肥胖			吸烟史			COPD
无并发症组		516		260/256			59.37±4.59			300（58.1）			160（31.0）	56（10.9）			355（68.8）			85（16.5）
并发症组		84		40/44			67.14±3.25			43（51.2）			27（32.1）	14（16.7）			65（77.4）			28（33.3）
χ²或t				0.221			19.030^＊＊			2.733							2.534			13.434^＊＊
组别			冠心病			高血压		2型糖尿病				术前KPS评分/分				DLCO%pred			病变侧别/右肺		低分化
无并发症组			30（5.8）			180（34.9）		60（11.6）				89.17±9.11				89.31±6.02			260（50.4）		120（23.3）
并发症组			12（14.3）			40（47.6）		20（23.8）				84.76±12.07				87.31±4.60			48（57.1）		24（28.6）
χ²或t			7.964^＊＊			5.045^＊		9.277^＊＊				3.202^＊＊				3.528^＊＊			1.320		1.119
组别	TNM分期 Ⅱ期				腺癌				手术时间/ min		术中失血量/ mL				单肺通气时间/ min			术中最低 SpO₂/%				FEV1%pred
无并发症组	220（42.6）				385（74.6）				165.71±20.78		161.46±52.32				99.53±18.58			91.86±6.18				81.67±7.04
并发症组	40（47.6）				61（72.6）				176.71±25.47		211.14±47.11				123.75±24.78			88.13±6.54				76.38±5.61
χ²或t	0.731				0.150				4.350^＊＊		8.821^＊＊				18.668^＊＊			6.094^＊＊				7.664^＊＊

指标	β	SE	Wald χ²	P	OR（95%CI）
年龄	0.605	0.090	45.726	<0.001	1.832（1.537~2.183）
COPD	1.914	0.473	16.397	<0.001	6.782（2.685~17.130）
术前KPS评分	-0.077	0.021	12.994	<0.001	0.926（0.888~0.965）
FEV1%pred	-0.099	0.036	7.597	0.006	0.906（0.845~0.972）
DLCO%pred	-0.105	0.041	6.620	0.010	0.901（0.832~0.975）
术中出血量	0.025	0.005	21.134	<0.001	1.025（1.014~1.036）
单肺通气时间	0.056	0.011	25.212	<0.001	1.057（1.034~1.080）
常数项	-28.092	7.352	14.600	<0.001	<0.001

指标	β	SE	Wald χ²	P	OR（95%CI）
年龄	0.605	0.090	45.726	<0.001	1.832（1.537~2.183）
COPD	1.914	0.473	16.397	<0.001	6.782（2.685~17.130）
术前KPS评分	-0.077	0.021	12.994	<0.001	0.926（0.888~0.965）
FEV1%pred	-0.099	0.036	7.597	0.006	0.906（0.845~0.972）
DLCO%pred	-0.105	0.041	6.620	0.010	0.901（0.832~0.975）
术中出血量	0.025	0.005	21.134	<0.001	1.025（1.014~1.036）
单肺通气时间	0.056	0.011	25.212	<0.001	1.057（1.034~1.080）
常数项	-28.092	7.352	14.600	<0.001	<0.001

变量	AUC（95%CI）	敏感度	特异度	截断值
联合诊断	0.977（0.965~0.989）	0.964	0.876	-
年龄	0.906（0.877~0.935）	1.000	0.653	61岁
COPD	0.584（0.515~0.654）	0.333	0.835	合并
术前KPS评分	0.397（0.321~0.473）	0.310	0.713	92分
FEV1%pred	0.299（0.249~0.348）	0.000	1.000	93%
术中出血量	0.740（0.690~0.791）	0.952	0.424	149 mL
单肺通气时间	0.785（0.725~0.846）	0.631	0.839	121 min
DLCO%pred	0.401（0.347~0.456）	0.905	0.101	80%