影响手术后预测和长期实际肺功能之间差异的临床因素

肺癌手术结果在很大程度上取决于术前肺部储备，而在1秒（FEV1）中强迫呼气量是关键的术前评估因子。 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结核病。使用SPECT/CT成像进行预测的术后肺功能。从216名患者（男性：150：66;年龄，67.9±8.7岁），预测术后FEV1％（PPOFEVEV1％）与实际术后FEV1％（r = 0.667; p <0.001; p <0.001）显示出显着的相关性。配对t检验表明，与实际术后FEV1％相比，PPOFEV1％明显降低（p <0.001）。该研究确定了视频辅助手术（VATS）（优势比[OR]，3.90; 95％置信区间[CI]，1.98-7.69; P <0.001）和更高的切除量的百分比（或每1％增加，或增加1.05; 95％CI； 95％CI，1.01-1.09; P = 0.01;相反，对于肺部功能术后的下降，重要的预测因子包括较低的切除肺部量的百分比（或增加1％，0.92； 95％CI，0.86-0.98; p = 0.011），术前FEV1％（OR，1.03; 95％CI，95％CI，1.01-1.07; p = 0.009; p = 0.009; p = 0.009），以及tuber and tuber，turcc; CI，1.48-18.15;此外，在一个边界肺功能的患者亚组中，VATS与改进有关。我们的发现表明，在超过一半的患者中，实际的术后肺功能超过了预测值，尤其是在谷类和肺部切除量更高之后。它还确定切除的肺部量较低，术前FEV1％和结核病是与肺功能术后下降相关的因素。该研究强调了需要精确的术前肺功能评估和量身定制的术后治疗，特别注意具有相关临床因素的患者。未来的研究应集中于验证临床因素，并探索量身定制的肺癌手术和康复方法。

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.