肺癌手术的结果在很大程度上取决于术前的肺储备，其中第一秒用力呼气量（FEV1）是术前关键的评估因素。我们的研究调查了预测和长期实际术后肺功能之间的差异，重点关注影响这些结果的临床因素。这项回顾性观察研究涵盖了 2015 年至 2021 年间接受术前肺灌注 SPECT/CT 的肺癌患者。我们评估了术前和术后肺功能检查，考虑手术类型、切除体积和患者病史（包括结核病史）等因素。使用 SPECT/CT 成像计算预测的术后肺功能。在 216 名患者（男：女，150：66；年龄，67.9 ± 8.7 岁）中，预测的术后 FEV1%（ppoFEV1%）与实际术后 FEV1%（r = 0.667；P < 0.001)。配对t检验显示ppoFEV1%明显低于术后实际FEV1%（P < 0.001）。该研究确定了电视辅助胸腔手术 (VATS)（比值比 [OR]，3.90；95% 置信区间 [CI]，1.98-7.69；P < 0.001）和较高的切除体积百分比（OR 每增加 1%，1.05） ；95% CI，1.01-1.09；P = 0.014）作为术后肺功能改善的显着预测因子。相反，对于术后肺功能下降，重要的预测因素包括较低的肺切除体积百分比（OR 每增加 1%，0.92；95% CI，0.86-0.98；P = 0.011）、术前 FEV1% 较高（OR，1.03；95% CI，0.86-0.98；P = 0.011）。 95% CI，1.01-1.07；P = 0.009），以及存在结核病（OR，5.19；95% CI，1.48-18.15；P = 0.010）。此外，在肺功能处于边缘的患者亚组中，VATS 与改善相关。我们的研究结果表明，在超过一半的患者中，实际术后肺功能超过了预测值，特别是在 VATS 和肺切除量较大之后。它还确定了较低的切除肺体积、较高的术前 FEV1% 和结核病是与术后肺功能下降相关的因素。该研究强调需要进行精确的术前肺功能评估和量身定制的术后管理，特别关注具有相关临床因素的患者。未来的研究应侧重于临床因素的验证并探索肺癌手术和康复的定制方法。版权所有 © 2024 Wolters Kluwer Health, Inc. 保留所有权利。

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.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.