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

Abstract

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.

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.

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 assessment75: 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 75: memory: yes) + 2 (albumin: <3.8 ng/ml) + 1 (percentage vital capacity: ≤90) + 1 (SCS: diabetes mellitus: yes).

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.

Trial Registration Number:

JACS1303 (UMIN000016756).

• Authors: Hisashi Saji, Takahiko Ueno, Hiroshige Nakamura, Norihito Okumura, Masanori Tsuchida, Makoto Sonobe, Takuro Miyazaki, Keiju Aokage, Masayuki Nakao, Tomohiro Haruki, Hiroyuki Ito, Kazuhiko Kataoka, Kazunori Okabe, Kenji Tomizawa, Kentaro Yoshimoto, Hirotoshi Horio, Kenji Sugio, Yasuhisa Ode, Motoshi Takao, Morihito Okada, Masayuki Chida, Committee for Scientific Affairs, The Japanese Association for Chest Surgery, Tokyo, Japan
• Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (Eur J Cardiothorac Surg) Vol. 53 Issue 4 Pg. 835-841 (04 01 2018) ISSN: 1873-734X [Electronic] Germany
• PMID: 29240884 (Publication Type: Journal Article, Multicenter Study)

Topics

• Age Factors
• Aged, 80 and over
• Female
• Hospital Mortality
• Humans
• Lung Neoplasms (mortality, surgery)
• Male
• Postoperative Complications (epidemiology, etiology)
• Prospective Studies
• Risk Assessment (methods)
• Risk Factors
• Sex Factors
• Smoking (adverse effects)