Assessment of the 90-day mortality risk score after video-assisted thoracoscopic lobectomy in the Italian VATS Group cohort
Abstract
A five-class (A-E) aggregate risk score predicting 90-day mortality after video-assisted thoracoscopic lobectomy for lung cancer, including as independent factors male sex (3 points), carbon monoxide lung diffusion capacity ≤60% (1 point), and operative time ≥150 minutes (1 point), has been recently published. This study aims to assess the effectiveness and reliability of this risk model in a large, independent cohort of patients to confirm its generalizability. From the Italian VATS Group database, we selected 2209 patients [60% males; median age 69 years (interquartile range: 63-74)] who underwent video-assisted thoracoscopic lobectomy for non-small cell lung cancer. We calculated the aggregate risk score and the corresponding class of 90-day mortality risk for each patient. The correlation between risk classes and mortality rates was tested by Spearman’s r-test. Model calibration was evaluated by the Hosmer-Lemeshow goodness-of-fit test. Class A-E 90-day mortality rates were 0.33%, 0.51%, 1.39%, 1.31%, and 2.56%, respectively. A strong uphill correlation was identified between risk classes and 90-day mortality (r=0.90; p=0.037), showing a positive correlation between increased mortality rate and classes A to E. Hosmer-Lemeshow Chi-squared value was 67.47 (p≤0.001), with overall, class D and E significantly lower 90-day mortality in our cohort than in the original one [1.04% versus 2.5% (p=0.018), 1.31% versus 5.65% (p=0.005) and 2.56% versus 18.75% (p=0.007), respectively]. Despite our data showing a positive correlation between 90-day mortality and risk classes from A to E with modest discriminatory performance, the poor calibration suggests the need for model recalibration using local data to better manage and counsel lung cancer patients eligible for video-assisted thoracoscopic lobectomy.
Keywords
Ethics Approval
The Ethics Committee approved the study (protocol number: 0033034; ClinTrials.gov ID: NCT04799509).
References
- NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). Non-small cell lung cancer. Version 3.2022. Available from: www.NCCN.org. Accessed on: 18/03/2022.
- Al-Ameri M, Bergman P, Franco-Cereceda A, Sartipy U. Video-assisted thoracoscopic versus open thoracotomy lobectomy: a Swedish nationwide cohort study. J Thorac Dis 2018;10:3499-506.
- Pezzi CM, Mallin K, Mendez AS, et al. Ninety-day mortality after resection for lung cancer is nearly double 30-day mortality. J Thorac Cardiovasc Surg 2014;148:2269-77.
- McMillan RR, Berger A, Sima CS, et al. Thirty-day mortality underestimates the risk of early death after major resections for thoracic malignancies. Ann Thorac Surg 2014;98:1769-74.
- Powell HA, Tata LJ, Baldwin DR, et al. Early mortality after surgical resection for lung cancer: an analysis of the English National Lung cancer audit. Thorax 2013;68:826-34.
- Hu Y, McMurry TL, Wells KM, et al. Postoperative mortality is an inadequate quality indicator for lung cancer resection. Ann Thorac Surg 2014;97:973-9.
- Green A, Hauge J, Iachina M, Jakobsen E. The mortality after surgery in primary lung cancer: results from the Danish Lung Cancer Registry. Eur J Cardiothorac Surg 2016;49:589-94.
- Bryant AS, Rudemiller K, Cerfolio RJ. The 30- versus 90-day operative mortality after pulmonary resection. Ann Thorac Surg 2010;89:1717-22.
- Stephens N, Rice D, Correa A, et al. Thoracoscopic lobectomy is associated with improved short-term and equivalent oncological outcomes compared with open lobectomy for clinical Stage I non-small-cell lung cancer: a propensity-matched analysis of 963 cases. Eur J Cardiothorac Surg 2014;46:607-13.
- Falcoz PE, Puyraveau M, Thomas PA, et al. Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small-cell lung cancer: a propensity-matched analysis of outcome from the European Society of Thoracic Surgeon database. Eur J Cardiothorac Surg 2016;49:602-9.
- Cao C, Manganas C, Ang SC, et al. Video-assisted thoracic surgery versus open thoracotomy for non-small cell lung cancer: a meta-analysis of propensity score-matched patients. Interact Cardiovasc Thorac Surg 2013;16:244-9.
- Brunelli A, Dinesh P, Woodcock-Shaw J, et al. Ninety-day mortality after video-assisted thoracoscopic lobectomy: incidence and risk factors. Ann Thorac Surg 2017;104:1020-6.
- Agha R, Abdall-Razak A, Crossley E, et al. STROCSS 2019 Guideline: strengthening the reporting of cohort studies in surgery. Int J Surg 2019;72:156-65.
- Ganai S, Ferguson MK. Can we predict morbidity and mortality before an operation?. Thorac Surg Clin 2013;23:287-99.
- Berrisford R, Brunelli A, Rocco G, et al. The European Thoracic Surgery Database project: modelling the risk of in-hospital death following lung resection. Eur J Cardiothorac Surg 2005;28:306-11.
- Brunelli A, Salati M, Rocco G, 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;51:490-7.
- Kozower BD, Sheng S, O’Brien SM, et al. STS database risk models: predictors of mortality and major morbidity for lung cancer resection. Ann Thorac Surg 2010;90:875-81.
- Falcoz PE, Conti M, Brouchet L, et al. The Thoracic Surgery Scoring System (Thoracoscore): risk model for in-hospital death in 15,183 patients requiring thoracic surgery. J Thorac Cardiovasc Surg 2007;133:325-32.
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