Stephen Gowing1, Laura Baker2, Alexandre Tran2, Zach Zhang3, Hilalion Ahn3, Jelena Ivanovic4,5, Caitlin Anstee1, Emma Grigor3, Sebastien Gilbert1, Donna E Maziak4,5,3,1, Farid Shamji1, Sudhir Sundaresan5,1, Patrick James Villeneuve1, Andrew J E Seely6,7,8,9. 1. Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, K1H 8L6, Canada. 2. Division of General Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Canada. 3. Faculty of Medicine, The University of Ottawa, 501 Smyth Road, Ottawa, Canada. 4. Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada. 5. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada. 6. Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada. aseely@toh.ca. 7. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada. aseely@toh.ca. 8. Faculty of Medicine, The University of Ottawa, 501 Smyth Road, Ottawa, Canada. aseely@toh.ca. 9. Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, K1H 8L6, Canada. aseely@toh.ca.
Abstract
BACKGROUND: Up to 50% of patients suffer short-term postoperative adverse events (AEs) and metastatic recurrence in the long-term following curative-intent lung cancer resection. The association between AEs, particularly infectious in nature, and disease recurrence is controversial. We sought to evaluate the association of postoperative AEs on risk of developing recurrence and recurrence-free survival (RFS) following curative-intent lung resection surgery. METHODS: All lung cancer resections at a single institution (January 2008-July 2015) were included, with prospective collection of AEs using the Thoracic Morbidity & Mortality System. Cox proportional hazards models were used to estimate the effect of AEs on recurrence, with results presented as hazard ratio (HR) with 95% confidence interval (CI). An a priori, clinically driven approach to predictor variable selection was used. Kaplan-Meier curves were used examine the relationship between AE and RFS. p < 0.05 was considered statistically significant. RESULTS: 892 patients underwent curative-intent resection. 342 (38.3%) patients experienced an AE; 69 (7.7%) patients developed infectious AEs. 17.6% (n = 157) of patients had disease recurrence after mean follow-up of 26.5 months. Severe (Grade IV) AEs were associated with increased risk of recurrence (3.40; 95% CI 1.56-7.41) and a trend to decreased RFS. Major infectious AEs were associated with increased risk of recurrence (HR 1.71; CI 1.05-2.8) and earlier time to recurrence (no infectious AE 66 months, minor infectious 41 months, major infectious 54 months; p = 0.02). CONCLUSION: For patients undergoing curative-intent lung cancer resection, postoperative AEs associated with critical illness or major infection were associated with increased risk of oncologic recurrence.
BACKGROUND: Up to 50% of patients suffer short-term postoperative adverse events (AEs) and metastatic recurrence in the long-term following curative-intent lung cancer resection. The association between AEs, particularly infectious in nature, and disease recurrence is controversial. We sought to evaluate the association of postoperative AEs on risk of developing recurrence and recurrence-free survival (RFS) following curative-intent lung resection surgery. METHODS: All lung cancer resections at a single institution (January 2008-July 2015) were included, with prospective collection of AEs using the Thoracic Morbidity & Mortality System. Cox proportional hazards models were used to estimate the effect of AEs on recurrence, with results presented as hazard ratio (HR) with 95% confidence interval (CI). An a priori, clinically driven approach to predictor variable selection was used. Kaplan-Meier curves were used examine the relationship between AE and RFS. p < 0.05 was considered statistically significant. RESULTS: 892 patients underwent curative-intent resection. 342 (38.3%) patients experienced an AE; 69 (7.7%) patients developed infectious AEs. 17.6% (n = 157) of patients had disease recurrence after mean follow-up of 26.5 months. Severe (Grade IV) AEs were associated with increased risk of recurrence (3.40; 95% CI 1.56-7.41) and a trend to decreased RFS. Major infectious AEs were associated with increased risk of recurrence (HR 1.71; CI 1.05-2.8) and earlier time to recurrence (no infectious AE 66 months, minor infectious 41 months, major infectious 54 months; p = 0.02). CONCLUSION: For patients undergoing curative-intent lung cancer resection, postoperative AEs associated with critical illness or major infection were associated with increased risk of oncologic recurrence.
Entities:
Keywords:
Adverse events; Cancer recurrence; Infection; Lung cancer; Surgery
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