A proposal for a comprehensive risk scoring system for predicting postoperative complications in octogenarian patients with medically operable lung cancer: JACS1303

作者：Saji Hisashi^*; Ueno Takahiko; Nakamura Hiroshige; Okumura Norihito; Tsuchida Masanori; Sonobe Makoto; Miyazaki Takuro; Aokage Keiju; Nakao Masayuki; Haruki Tomohiro; Ito Hiroyuki; Kataoka Kazuhiko; Okabe Kazunori; Tomizawa Kenji; Yoshimoto Kentaro; Horio Hirotoshi; Sugio Kenji; Ode Yasuhisa; Takao Motoshi; Okada Morihito; Chida Masayuki

来源：European Journal of Cardio-Thoracic Surgery, 2018, 53(4): 835-841.

DOI：10.1093/ejcts/ezx415

• Lung cancer
• Octogenarian
• Postoperative complication
• Risk scoring system

OBJECTIVES: Although some retrospective studies have reported clinicopathological scoring systems for predicting postoperative complications and survival outcomes for elderly lung cancer patients, optimized scoring systems remain controversial.& para;& para;METHODS: The Japanese Association for Chest Surgery (JACS) conducted a nationwide multicentre prospective cohort and enrolled a total of 1019 octogenarians with medically operable lung cancer. Details of the clinical factors, comorbidities and comprehensive geriatric assessment were recorded for 895 patients to develop a comprehensive risk scoring (RS) system capable of predicting severe complications.& para;& para;RESULTS: Operative (30 days) and hospital mortality rates were 1.0% and 1.6%, respectively. Complications were observed in 308 (34%) patients, of whom 81 (8.4%) had Grade 3-4 severe complications. Pneumonia was the most common severe complication, observed in 27 (3.0%) patients. Five predictive factors, gender, comprehensive geriatric assessment7(5) : memory and Simplified Comorbidity Score (SCS): diabetes mellitus, albumin and percentage vital capacity, were identified as independent predictive factors for severe postoperative complications (odds ratio = 2.73, 1.86, 1.54, 1.66 and 1.61, respectively) through univariate and multivariate analyses. A 5-fold cross-validation was performed as an internal validation to reconfirm these 5 predictive factors (average area under the curve 0.70). We developed a simplified RS system as follows: RS = 3 (gender male) + 2 (comprehensive geriatric assessment 7(5) : memory: yes) + 2 (albumin: <3.8 ng/ml) + 1 (percentage vital capacity: <= 90) + 1 (SCS: diabetes mellitus: yes).& para;& para;CONCLUSIONS: The current series shows that octogenarians can be successfully treated for lung cancer with surgical resection with an acceptable rate of severe complications and mortality. We propose a simplified RS system to predict severe complications in octogenarian patients with medically operative lung cancer.

• 出版日期2018-4