手术后预测肺功能与实际长期肺功能差异的临床因素分析

肺癌手术效果高度依赖于术前肺储备能力，强制呼气量（FEV1）是重要的术前评估指标。我们的研究旨在探讨预测值与实际长期术后肺功能之间的差异，并重点分析影响这些差异的临床因素。本回顾性观察研究包括2015年至2021年接受术前肺灌注SPECT/CT的肺癌患者。评估术前与术后肺功能，考虑手术类型、切除体积和患者病史（如结核感染）等因素。预测的术后肺功能通过SPECT/CT成像计算。共纳入216例患者（男150例，女66例；平均年龄67.9±8.7岁），预测的术后FEV1%（ppoFEV1%）与实际术后FEV1%显著相关（r=0.667；P<0.001）。配对t检验显示，ppoFEV1%显著低于实际值（P<0.001）。多因素回归分析显示，VATS（视频辅助胸腔镜手术）（比值比[OR] 3.90，95% CI：1.98-7.69；P<0.001）和较高的切除体积百分比（每增加1%，OR 1.05，95% CI：1.01-1.09；P=0.014）是术后肺功能改善的显著预测因素。相反，术后肺功能下降的显著预测因素包括较低的切除肺体积百分比（每增加1%，OR 0.92，95% CI：0.86-0.98；P=0.011）、较高的术前FEV1%（OR 1.03，95% CI：1.01-1.07；P=0.009）及结核感染（OR 5.19，95% CI：1.48-18.15；P=0.010）。在肺功能边界患者的亚组中，VATS与改善相关。我们的发现显示，在超过一半的患者中，实际术后肺功能优于预测值，尤其在采用VATS和较大手术体积时。同时，较低的切除肺体积、较高的术前FEV1%及结核感染与术后肺功能下降相关。本研究强调需要精确的术前肺功能评估及个性化的术后管理，特别关注具有相关临床因素的患者。未来应验证这些临床因素，并探索个性化的肺癌手术和康复策略。

Lung cancer surgery outcomes depend heavily on preoperative pulmonary reserve, with forced expiratory volume in 1 second (FEV1) being a critical preoperative evaluation factor. Our study investigates the discrepancies between predicted and long-term actual postoperative lung function, focusing on clinical factors affecting these outcomes.This retrospective observational study encompassed lung cancer patients who underwent preoperative lung perfusion SPECT/CT between 2015 and 2021. We evaluated preoperative and postoperative pulmonary function tests, considering factors such as surgery type, resected volume, and patient history including tuberculosis. Predicted postoperative lung function was calculated using SPECT/CT imaging.From 216 patients (men:women, 150:66; age, 67.9 ± 8.7 years), predicted postoperative FEV1% (ppoFEV1%) showed significant correlation with actual postoperative FEV1% ( r = 0.667; P < 0.001). Paired t test revealed that ppoFEV1% was significantly lower compared with actual postoperative FEV1% ( P < 0.001). The study identified video-assisted thoracic surgery (VATS) (odds ratio [OR], 3.90; 95% confidence interval [CI], 1.98-7.69; P < 0.001) and higher percentage of resected volume (OR per 1% increase, 1.05; 95% CI, 1.01-1.09; P = 0.014) as significant predictors of postsurgical lung function improvement. Conversely, for the decline in lung function postsurgery, significant predictors included lower percentage of resected lung volume (OR per 1% increase, 0.92; 95% CI, 0.86-0.98; P = 0.011), higher preoperative FEV1% (OR, 1.03; 95% CI, 1.01-1.07; P = 0.009), and the presence of tuberculosis (OR, 5.19; 95% CI, 1.48-18.15; P = 0.010). Additionally, in a subgroup of patients with borderline lung function, VATS was related with improvement.Our findings demonstrate that in more than half of the patients, actual postsurgical lung function exceeded predicted values, particularly following VATS and with higher volume of lung resection. It also identifies lower resected lung volume, higher preoperative FEV1%, and tuberculosis as factors associated with a postsurgical decline in lung function. The study underscores the need for precise preoperative lung function assessment and tailored postoperative management, with particular attention to patients with relevant clinical factors. Future research should focus on validation of clinical factors and exploring tailored approaches to lung cancer surgery and recovery.