TY - JOUR
T1 - Association of Preoperative Lung Function with Complications after Lobectomy Using Race-Neutral and Race-Specific Normative Equations
AU - Sheshadri, Ajay
AU - Rajaram, Ravi
AU - Baugh, Aaron
AU - Castro, Mario
AU - Correa, Arlene M.
AU - Soto, Felipe
AU - Daniel, Carrie R.
AU - Li, Liang
AU - Evans, Scott E.
AU - Dickey, Burton F.
AU - Vaporciyan, Ara A.
AU - Ost, David E.
N1 - Publisher Copyright:
Copyright © 2024 by the American Thoracic Society.
PY - 2024/1/1
Y1 - 2024/1/1
N2 - Rationale: Pulmonary function testing (PFT) is performed to aid patient selection before surgical resection for non–small cell lung cancer (NSCLC). The interpretation of PFT data relies on normative equations, which vary by race, but the relative strength of association of lung function using race-specific or race-neutral normative equations with postoperative pulmonary complications is unknown. Objectives: To compare the strength of association of lung function, using race-neutral or race-specific equations, with surgical complications after lobectomy for NSCLC. Methods: We studied 3,311 patients who underwent lobectomy for NSCLC and underwent preoperative PFT from 2001 to 2021. We used Global Lung Function Initiative equations to generate race-specific and race-neutral normative equations to calculate percentage predicted forced expiratory volume in 1 second (FEV1%). The primary outcome of interest was the occurrence of postoperative pulmonary complications within 30 days of surgery. We used unadjusted and race-adjusted logistic regression models and least absolute shrinkage and selection operator analyses adjusted for relevant comorbidities to measure the association of race-specific and race-neutral FEV1% with pulmonary complications. Results: Thirty-one percent of patients who underwent surgery experienced pulmonary complications. Higher FEV1, whether measured with race-neutral (odds ratio [OR], 0.98 per 1% change in FEV1% [95% confidence interval (CI), 0.98–0.99]; P, 0.001) or race-specific (OR, 0.98 per 1% change in FEV1% [95% CI, 0.98–0.98]; P, 0.001) normative equations, was associated with fewer postoperative pulmonary complications. The area under the receiver operator curve for pulmonary complications was similar for race-adjusted race-neutral (0.60) and race-specific (0.60) models. Using least absolute shrinkage and selection operator regression, higher FEV1% was similarly associated with a lower rate of pulmonary complications in race-neutral (OR, 0.99 per 1% [95% CI, 0.98–0.99]) and race-specific (OR, 0.99 per 1%; 95% CI, 0.98–0.99) models. The marginal effect of race on pulmonary complications was attenuated in all race-specific models compared with all race-neutral models. Conclusions: The choice of race-specific or race-neutral normative PFT equations does not meaningfully affect the association of lung function with pulmonary complications after lobectomy for NSCLC, but the use of race-neutral equations unmasks additional effects of self-identified race on pulmonary complications.
AB - Rationale: Pulmonary function testing (PFT) is performed to aid patient selection before surgical resection for non–small cell lung cancer (NSCLC). The interpretation of PFT data relies on normative equations, which vary by race, but the relative strength of association of lung function using race-specific or race-neutral normative equations with postoperative pulmonary complications is unknown. Objectives: To compare the strength of association of lung function, using race-neutral or race-specific equations, with surgical complications after lobectomy for NSCLC. Methods: We studied 3,311 patients who underwent lobectomy for NSCLC and underwent preoperative PFT from 2001 to 2021. We used Global Lung Function Initiative equations to generate race-specific and race-neutral normative equations to calculate percentage predicted forced expiratory volume in 1 second (FEV1%). The primary outcome of interest was the occurrence of postoperative pulmonary complications within 30 days of surgery. We used unadjusted and race-adjusted logistic regression models and least absolute shrinkage and selection operator analyses adjusted for relevant comorbidities to measure the association of race-specific and race-neutral FEV1% with pulmonary complications. Results: Thirty-one percent of patients who underwent surgery experienced pulmonary complications. Higher FEV1, whether measured with race-neutral (odds ratio [OR], 0.98 per 1% change in FEV1% [95% confidence interval (CI), 0.98–0.99]; P, 0.001) or race-specific (OR, 0.98 per 1% change in FEV1% [95% CI, 0.98–0.98]; P, 0.001) normative equations, was associated with fewer postoperative pulmonary complications. The area under the receiver operator curve for pulmonary complications was similar for race-adjusted race-neutral (0.60) and race-specific (0.60) models. Using least absolute shrinkage and selection operator regression, higher FEV1% was similarly associated with a lower rate of pulmonary complications in race-neutral (OR, 0.99 per 1% [95% CI, 0.98–0.99]) and race-specific (OR, 0.99 per 1%; 95% CI, 0.98–0.99) models. The marginal effect of race on pulmonary complications was attenuated in all race-specific models compared with all race-neutral models. Conclusions: The choice of race-specific or race-neutral normative PFT equations does not meaningfully affect the association of lung function with pulmonary complications after lobectomy for NSCLC, but the use of race-neutral equations unmasks additional effects of self-identified race on pulmonary complications.
KW - lobectomy
KW - non–small cell lung cancer
KW - pulmonary complications
KW - pulmonary function testing
KW - race-based interpretation
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U2 - 10.1513/AnnalsATS.202305-396OC
DO - 10.1513/AnnalsATS.202305-396OC
M3 - Article
C2 - 37796618
AN - SCOPUS:85181396365
SN - 2329-6933
VL - 21
SP - 38
EP - 46
JO - Annals of the American Thoracic Society
JF - Annals of the American Thoracic Society
IS - 1
ER -