|Year : 2017 | Volume
| Issue : 3 | Page : 57-61
A preliminary study on forced expiratory volume in 1 s/forced vital capacity to predict prognosis of patients with lung cancer
Yechi Li, Jingqi Tian
Thyroid and Breast Department of Surgery, Dalian Hospital of Shengjing Hospital of China Medical University, Dalian, Liaoning, China
|Date of Submission||15-Dec-2016|
|Date of Acceptance||05-May-2017|
|Date of Web Publication||15-Sep-2017|
Thyroid and Breast Department of Surgery, Dalian Hospital of Shengjing Hospital of China Medical University, Dalian 116600, Liaoning
Source of Support: None, Conflict of Interest: None
Aim: The purpose of the study is to verify if there is statistic difference of lung function before surgery based on differences in clinical characteristics (sex, age, degree of differentiation, size of tumor, tumor node metastasis (TNM), methods of surgeries, pleural metastasis, and lymph gland metastasis). Another purpose is to test if forced expiratory volume in 1 s/forced vital capacity obstruction (FEV1/FVC) is a risk factor of the prognosis of lung cancer. Methods: This retrospective study used t-test or analysis of variance to explore whether dramatic difference of lung function (FVC, FEV1, maximal voluntary ventilation [MVV], and FEV1/FVC) existed based on differences in clinical characteristics. The study used the Kaplan–Meier method to verify if FEV1/FVC could be a risk factor to predict the prognosis of lung cancer patients after surgeries. Results: The statistical results indicated that statistical difference of FVC existed between different age groups. In patients of different ages and sexes, there was statistically different MVV. Results of FEV1/FVC showed that FEV1/FVC varied dramatically in patients of different pleural metastasis conditions or TNM. Analysis of prognosis proved that in patients with a different differentiation degree, size of tumor, metastasis conditions of lymph gland, and TNM stage, a statistically different prognosis was found. As for groups of normal and abnormal FEV1/FVC, no apparently different prognosis was observed. Analysis of lung cancer patients of stage I indicated that the 5-year survival was dramatically different between patients of normal and abnormal FEV1/FVC. Conclusion: In lung cancer patients of stage I, FEV1/FVC was one of the risk factors of prognosis.
Keywords: Forced expiratory volume in 1 s/forced vital capacity, lung cancer, lung function, prognosis
|How to cite this article:|
Li Y, Tian J. A preliminary study on forced expiratory volume in 1 s/forced vital capacity to predict prognosis of patients with lung cancer. Transl Surg 2017;2:57-61
|How to cite this URL:|
Li Y, Tian J. A preliminary study on forced expiratory volume in 1 s/forced vital capacity to predict prognosis of patients with lung cancer. Transl Surg [serial online] 2017 [cited 2019 Dec 9];2:57-61. Available from: http://www.translsurg.com/text.asp?2017/2/3/57/211070
| Introduction|| |
A relatively high morbidity exists in lung cancer.,, The morbidity of lung cancer in men was the highest among all kinds of cancers, and it is also high in women.,, Thus, estimating prognosis of lung cancer is important. Currently, the main factors for predicting the prognosis are pathological type, tumor node metastasis stage (TNM), metastasis, and tumor markers., Pulmonary function is an important factor affecting the safety of surgeries, so it is possible that pulmonary function can also estimate the prognosis of lung cancer.
Clinically, vital capacity (VC), total lung capacity, maximal voluntary ventilation (MVV), FVC, FEV1, FEV1/FVC, and peak expiratory flow (PEF) are commonly used to evaluate pulmonary function., Considering feasibility, FVC, FEV1, MVV, and FEV1/FVC were chosen in this study. FVC is all the amount of air, after deep inhalation, with full power and speed. FEV1 is the amount of air in the first second, after deep inhalation. MVV is the amount of air within 1 min, with full power and speed.
Recently, FVC, FEV1, and MVV have been widely used clinically, and their relationship with prognosis of lung cancer has been reported. It has been reported that FVC and FEV1 decreased dramatically after lung cancer surgery. Some papers have indicated that pulmonary function could affect outcomes of nonsmall cell lung cancer (NSCLC), and FVC could be an independent risk factor affecting prognosis of NSCLC.,
The study by Launo et al. showed that low MVV could increase the morbidity, mortality, and operative risk. However, the concept that FEV1 could be an independent risk factor of outcomes is controversial. Lin et al. indicated that FEV1 could be an independent risk factor of prognosis, but FEV1 before surgeries could not be used to evaluate the outcomes in study carried out by Guo and Du.
In summary, it is possible that pulmonary function can be used to evaluate outcomes of lung cancer. However the relationship between FEV1/FVC and outcomes remains unclear. Besides, it is controversial that patients with different clinical characters have statistically different pulmonary function such as FVC, FEV1, MVV, and FEV1/FVC.
In our study, data on 248 patients with a diagnosis of lung cancer by surgery or pathology were collected. This was a retrospective study. Data were analyzed statistically to verify whether patients with different clinical characteristics (sex, age, degree of differentiation, size of tumor, TNM, methods of surgeries, pleural metastasis, and lymph gland metastasis) had statistically different pulmonary function. Another purpose of the study was to test whether decrease of FEV1/FVC can be used to evaluate outcomes of patients in stage I lung cancer.
| Methods|| |
We collected lung cancer cases after surgery in the Department of Thoracic Surgery, First Affiliated Hospital of Dalian Medical University from January 2008 to December 2013. In total, 248 patients were included in the study. All the cases were diagnosed with lung cancer pathologically. The data after surgery were obtained by telephone or outpatient service. Basic data such as sex, age, degree of differentiation, the size of tumor, TNM stages, methods of surgeries, pleural metastasis, lymph gland metastasis, FVC, FEV1, MVV, FEV1/FVC, and 5-year survival of all patients were collected.
Evaluation of pulmonary function
In men, normal MVV is 104 ± 2.71 L, while in women, normal MVV is 82.5 ± 2.17 L. Abnormal MVV is below 80% of expectation. In men, normal FVC is 3179 ± 117 mL, while in women, normal FVC is 2314 ± 48 mL, and abnormal FEV1/FVC is below 70%.
This retrospective study used t-test or analysis of variance to explore whether statistically significant difference of lung function (FVC, FEV1, MVV, and FEV1/FVC) existed in patients whose clinical characters (sex, age, degree of differentiation, size of tumor, TNM stage, methods of surgeries, pleural metastasis, and lymph gland metastasis) were different. The study used the Kaplan–Meier method to verify if decrease of FEV1/FVC could be a risk factor used to predict the prognosis of lung cancer patients after surgeries. The survival curve was calculated by SPSS. In the study, FEV1/FVC lower than 70% was considered to be abnormal. In the study, SPSS 20.0 (IBM, Armonk, New York, USA) was used to analyze the data. When P < 0.05, the difference was considered statistically significant.
| Results|| |
In patients of different clinical characters, statistical difference of forced vital capacity, forced expiratory volume in 1 s, maximal voluntary ventilation, and forced expiratory volume in 1 s/forced vital capacity
In [Table 1], the analysis of clinical characteristics and lung function indicated that there was a statistically significant difference of FVC between different age groups (≤62 and >62, P = 0.049). In this study, the median of age was 62. FVC of the age group ≤ 62 was 84.44% ± 13.49%, and FVC of another group was 81.04% ± 13.24%.
|Table 1: Difference between 248 lung cancer patients' clinical characteristics and forced vital capacity or forced expiratory volume in 1 s|
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In [Table 2], in patients of different ages and sexes, statistically different MVV was found (P < 0.001, P = 0.003). MVV of men was 84.71 ± 19.36 while MVV of women was 92.92 ± 22.63. MVV of the age group ≤ 62 was 96.64 ± 21.50 while MVV of another group was 81.97 ± 19.22. Results of FEV1/FVC showed that a statistically significant difference of FEV1/FVC was observed in patients of different pleural metastasis conditions or TNM (P = 0.002, P = 0.01).
|Table 2: Difference between 248 lung cancer patients' clinical characteristics and maximal voluntary ventilation or forced vital capacity/forced expiratory volume in 1 s|
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Single factor analysis of 248 lung cancer cases' clinical characters and outcomes
[Figure 1] shows the survival curve of patients with normal and abnormal FEV1/FVC. No statistically significant difference in 5-year survival was found between normal and abnormal FEV1/FVC (P = 0.299). In [Figure 1], horizontal axis is time, and vertical axis is survival rate. Five-year survival of patients with normal FEV1/FVC was 70.3% while that of patients with abnormal FEV1/FVC was 55.9%.
|Figure 1: Survival curve of normal forced expiratory volume in 1 s/forced vital capacity and abnormal forced expiratory volume in 1 s/forced vital capacity|
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In [Table 3], analysis of prognosis showed that in patients with different differentiation degree, size of tumor, metastasis conditions of lymph glands, and TNM stage, a statistically significant different prognosis was found after surgeries (P = 0.006, P = 0.002, P = 0.004, and P = 0.016). [Figure 2] is the survival curve of patients with different TNM stages. Five-year survival of stage I, II, and III was 82.3%, 60.4%, and 33.7%, respectively.
|Table 3: Single factor analysis of 248 lung cancer patients' clinical characteristic and prognosis|
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|Figure 2: Survival curve of lung cancer patients of stage I, II, and III|
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Single factor analysis of 75 stage I lung cancer patients' forced expiratory volume in 1 s/forced vital capacity and prognosis
Analysis of patients with stage I lung cancer indicated that statistically significant difference in outcomes was observed between patients with normal and abnormal FEV1/FVC (P = 0.024). The 5-year survival of patients with normal FEV1/FVC was 94.1% while that of those with abnormal FEV1/FVC was 74.8%. [Figure 3] is the survival curve of normal and abnormal FEV1/FVC in 75 patients with stage I lung cancer.
|Figure 3: Survival curve of normal forced expiratory volume in 1 s/forced vital capacity and abnormal forced expiratory volume in 1 s/forced vital capacity in patients with stage I lung cancer|
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| Discussion|| |
Currently, lung cancer has become the carcinoma of highest mortality, and the surgery is still an important method of treatment., TNM stage has been the most common method of evaluating prognosis, but it has intrinsic limitations. Hwang et al. indicated that inhospital mortality of lung cancer did not relate to sex, age, and performance status but to severity of organ failure. FVC, FEV1, and FEV1/FVC were effective methods of measuring pulmonary function. Ge et al. reported that, VC, FEV1, FVC, PEF, PEF%, and MVV correlated with outcomes of advanced lung cancer. Of all the pulmonary function indices, FEV1 was the most significant index evaluating surgery's risk. Magdeleinat et al. indicated that if FEV1 or FEV1/FVC was below 50%, there would be 8.5% mortality or 70% complication.
As lung cancer has a very high incidence of mortality, evaluating prognosis evaluating prognosis is significant. Pulmonary function is very important in evaluating the risk of surgery, so we assumed that pulmonary function could be used to evaluate the prognosis of lung cancer. The relationship of FVC, FEV1, MVV, and outcomes has been reported. However, FEV1/FVC was chosen in this study. Two hundred and forty-eight lung cancer cases were collected in this retrospective study to explore whether lung function (FVC, FEV1, MVV, and FEV1/FVC) had statistical difference in patients with different clinical characteristics. The study used the Kaplan–Meier Method to test if FEV1/FVC could be a risk factor to foresee the prognosis of lung cancer patients after surgeries.
Our data showed that statistically different FVC was found in patients of different age groups. Patients of different ages and sexes had statistically significant different MVV. Results of FEV1/FVC show that a statistically significant difference of FEV1/FVC was found among patients with different pleural metastasis conditions or TNM. Interestingly, degree of differentiation, size of tumor, and lymph metastasis are the indexes reflecting cancer progression, but statistically significant difference of FEV1/FVC did not exist. We assumed that these indexes were single ones which could not reflect the whole picture of patients.
Data about 5-year survival showed that patients with different differentiation degree, size of tumor, metastasis conditions of lymph gland, and TNM stage had statistically significant different outcomes after surgeries. However, no statistically significant difference of outcome was observed between normal and abnormal FEV1/FVC. The reason needs to be studied in the coming research.
To explore the relation of outcome and FEV1/FVC, 75 patients with stage I lung cancer were chosen. In stage II or III patients, number of normal FEV1/FVC is too small. Analysis of stage I lung cancer patients indicates that statistically significant difference of 5-year survivals existed between patients with normal and abnormal FEV1/FVC. In patients of all stages, FEV1/FVC did not affect outcomes, while in patients of stage I, it did. We believe that results in stage I were reliable and results of all stages need to be explored in the future.
The main innovation part of this study was the exploration of the relation of FEV1/FVC and outcomes in lung cancer. Because of certain statistical problems, in the study, the relation between FEV1/FVC of patients of stage II or III and outcome could not be researched. Further studies with larger samples are needed to address the aforementioned problem.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Fu QF, Liu Y, Fan Y, Hua SN, Qu HY, Dong SW, Li RL, Zhao MY, Zhen Y, Yu XL, Chen YY, Luo RC, Li R, Li LB, Deng XJ, Fang WY, Liu Z, Song X. Alpha-enolase promotes cell glycolysis, growth, migration, and invasion in non-small cell lung cancer through FAK-mediated PI3K/AKT pathway. J Hematol Oncol
Khazaei S, Mohammadian-Hafshejani A, Salehiniya H. Role of smoking in lung cancer in United States. Iran J Public Health
Noone AM, Cronin KA, Altekruse SF, Howlader N, Lewis DR, Petkov VI, Penberthy L. Cancer incidence and survival trends by subtype using data from the surveillance Epidemiology and End Results Program, 1992-2013. Cancer Epidemiol Biomarkers Prev
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin
Park BJ, Snider JM, Bates NR, Cassivi SD, Jett GK, Sonett JR, Toloza EM. Prospective evaluation of biodegradable polymeric sealant for intraoperative air leaks. J Cardiothorac Surg
Venuta F, Diso D, Onorati I, Anile M, Mantovani S, Rendina EA. Lung cancer in elderly patients. J Thorac Dis
2016;8 (Suppl 11):S908-14.
Niu R, Wang Y, Zhu M, Wen Y, Sun J, Shen W, Cheng Y, Zhang J, Jin G, Ma H, Hu Z, Shen H, Dai J. Potentially functional polymorphisms in POU5F1 gene are associated with the risk of lung cancer in Han Chinese. Biomed Res Int
Weder W, Inci I. Carinal resection and sleeve pneumonectomy. J Thorac Dis
2016;8 (Suppl 11):S882-8.
Zhiyu W, Rui Z, Shuai W, Hui Z. Surgical treatment of patients with lung cancer and bone metastases: A prospective, observational study. Lancet
2016;388 (Suppl 1):S42.
Aftab RA, Khan AH, Syed Sulaiman SA, Ali I, Hassali A, Saleem F. An assessment of adherence to asthma medication guidelines: Findings from a tertiary care center in the state of Penang, Malaysia. Turk J Med Sci
Pinto S, de Carvalho M. Correlation between forced vital capacity and slow vital capacity for the assessment of respiratory involvement in amyotrophic lateral sclerosis: A prospective study. Amyotroph Lateral Scler Frontotemporal Degener
Araújo AS, Nogueira IC, Gomes Neto A, de Medeiros IL, Morano MT, da Silva GP, Santos FA, De Moraes Filho MO, Pereira ED. The impact of lung cancer resection surgery on fibrinogen and C-reactive protein and their relationship with patients outcomes: A prospective follow up study. Cancer Biomark
Launo C, Palermo S, Riello R, Cammardella MP, Invitto V, Cerana M. Respiratory function tests and operative risk in thoracic surgery. Minerva Anestesiol
Dziedzic DA, Rudzinski P, Langfort R, Orlowski T. Risk factors for local and distant recurrence after surgical treatment in patients with non-small-cell lung cancer. Clin Lung Cancer
Zaidi Z, Hamdi Cherif M. PS01.07: Geographical distribution of lung cancer mortality worldwide: Topic: Pathology. J Thorac Oncol
Simmons CP, Koinis F, Fallon MT, Fearon KC, Bowden J, Solheim TS, Gronberg BH, McMillan DC, Gioulbasanis I, Laird BJ. Prognosis in advanced lung cancer – A prospective study examining key clinicopathological factors. Lung Cancer
Hwang KE, Seol CH, Hwang YR, Jo HG, Park SH, Yoon KH, Park DS, Jeong ET, Kim HR. The prognosis of patients with lung cancer admitted to the medical Intensive Care Unit. Asia Pac J Clin Oncol
Ding Y, Xu J, Yao J, Chen Y, He P, Ouyang Y, Niu H, Tian Z, Sun P. The analyses of risk factors for COPD in the Li ethnic group in Hainan, People's Republic of China. Int J Chron Obstruct Pulmon Dis
Ge H, Jiang Z, Huang Q, Zhu M, Yang J. Correlation between pulmonary function indexes and survival time in patients with advanced lung cancer. Zhongguo Fei Ai Za Zhi
Magdeleinat P, Seguin A, Alifano M, Boubia S, Regnard JF. Early and long-term results of lung resection for non-small-cell lung cancer in patients with severe ventilatory impairment. Eur J Cardiothorac Surg
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]