Chronic Progression of Lung Cancer Recurrence After Surgery: Warning Role of Postoperative Pneumonia

Figures & data

Table 1 Clinical Characteristics of Patients with or without PPFS

	Non-PPFS Patients (N=181)	PPFS Patients (N=151)	P-value
Patients characteristics, n (%)
Age (years)
<55	37 (20.44)	32 (21.19)	0.867
≥55	144 (79.56)	119 (78.81)
Sex
Male	107 (59.12)	96 (63.58)	0.406
Female	74 (40.88)	55 (36.42)
Smoking
No	99 (54.70)	81 (53.64)	0.848
Yes	82 (45.30)	70 (46.36)
Quit smoking
<0.5 year	169 (93.37)	133 (88.08)	0.094
≥0.5 year	12 (6.63)	18 (11.92)
Medications, n (%)
Pulmicort respules (0.5 mg)
No	66 (36.46)	58 (38.41)	0.715
Yes	115 (63.54)	93 (61.59)
Piperacillin sodium Tazobactam sodium (4.5 g)
No	25 (13.81)	10 (6.62)	0.034*
Yes	156 (86.19)	141 (93.38)
Compound ipratropium Bromide solution (2.5 mL)
No	38 (20.99)	42 (27.81)	0.148
Yes	143 (79.01)	109 (72.19)
Ambroxol hydrochloride (30 mg)
No	38 (20.99)	19 (12.58)	0.043*
Yes	143 (79.01)	132 (87.42)
Postoperative treatments, n (%)
Chemotherapy
No	105 (58.01)	69 (45.70)	0.025*
Yes	76 (41.99)	82 (54.30)
Targeted therapy
No	168 (92.82)	138 (91.39)	0.630
Yes	13 (7.18)	13 (8.61)
Radiotherapy
No	172 (95.03)	138 (91.39)	0.185
Yes	9 (4.97)	13 (8.61)
Perioperative conditions, n (%)
Blood loss
<200 mL	114 (62.98)	79 (52.32)	0.050*
≥200 mL	67 (37.02)	72 (47.68)

Notes: *Significant difference compared between-groups (p < 0.05).

Abbreviations: PPFS, postoperative pneumonia in 4–6 months; PPST, postoperative pneumonia in 7–12 month.

Figure 1 Flow of the retrospective study.

Figure 2 Patients with lung adenocarcinoma with driver mutations who received targeted therapy.

Abbreviations: EGFR mutation, epidermal growth factor receptor gene mutation; ALK fusion, anaplastic lymphoma receptor tyrosine kinase gene fusion; ROS1 fusion, reactive oxygen species proto-oncogene 1 fusion.

Table 2 Preoperative and Postoperative Pneumonia Occurrence, Recovery, and Outcome of Patients with or without PPFS

	Non-PPFS Patients (N=181)	PPFS Patients (N=151)	P-value
Preoperative pneumonia, n (%)
No	96 (53.04)	61 (40.40)	0.022*
Yes	85 (46.96)	90 (59.60)
PPT
No	43 (23.76)	20 (13.25)	0.015*
Yes	138 (76.24)	131 (86.75)
PPOT
No	138 (76.24)	30 (19.87)	P<0.001**
Yes	43 (23.76)	121 (80.13)
Recovery situation, n (%)
Recovery in 30 days
No	55 (30.39)	96 (63.58)	P<0.001**
Yes	126 (69.61)	55 (36.42)
Lung outcomes, n (%)
PPST
No	137 (75.69)	28 (18.54)
Yes	44 (24.31)	123 (81.46)	P<0.001**
LRO
No	159 (87.85)	76 (50.33)	P<0.001**
Yes	22 (12.15)	75 (49.67)
RAEs
No	179 (98.90)	148 (98.01)	0.511
Yes	2 (1.10)	3 (1.99)
Mortality
No	181 (100.00)	148 (98.01)	0.057
Yes	0 (0.00)	3 (1.99)

Notes: *Significant difference compared between-groups (p < 0.05). **Significant difference compared between-groups (p < 0.01).

Abbreviations: PPT, postoperative pneumonia in 30 days; PPOT, postoperative pneumonia in 1–3 months; PPFS, postoperative pneumonia in 4–6 months; PPST, postoperative pneumonia in 7–12 month; LRO, lung cancer recurrence within one year; RAE, respiratory adverse events.

Table 3 Risks for Development of PPST According to Postoperative Pneumonia Occurrence and Stage

	PPST		LRO
	OR (95% CI)	P-value	OR (95% CI)	P-value
Non-PPOT	Reference	–	Reference	–
PPOT occurrence	4.604 (1.927–11.001)	0.001**	0.669 (0.330–1.357)	0.265
Non-PPFS	Reference	–	Reference	–
PPFS occurrence	2.886 (1.193–6.978)	0.019*	2.793 (1.406–5.552)	0.003**
Non-PPST			Reference	–
PPST occurrence	–	–	16.271 (6.757–39.182)	P<0.001**

Notes: *Significant difference compared between-groups (p < 0.05). **Significant difference compared between-groups (p < 0.01).

Abbreviations: PPOT, postoperative pneumonia in 1–3 months; PPFS, postoperative pneumonia in 4–6 months; PPST, postoperative pneumonia in 7–12 month; LRO, lung cancer recurrence within one year; OR, odds ratio; CI, confidence interval.

Table 4 Multivariable Logistic Regression Analysis of Risk Factors for PPFS, PPST, and LRO Patients

Event	Risk Factor	OR (95% CI)	P-value
PPFS	Chemotherapy	2.402 (1.314–4.389)	0.004**
	TNM stage	0.716 (0.556–0.922)	0.010*
	Lymphatic metastasis	4.263 (1.691–10.746)	0.002**
	PPOT	16.757 (9.281–30.255)	P<0.001**
PPST	Chemotherapy	2.038 (1.021–4.067)	0.043 *
	ICU stay	9.286 (2.094–41.176)	0.003**
	Operation time	2.265 (1.077–4.764)	0.031*
	Antibacterials	3.455 (1.125–10.604)	0.030*
	PPOT	3.967 (2.063–7.628)	P<0.001**
	PPFS	8.382 (4.304–16.323)	P<0.001**
LRO	Smoking	2.380 (1.107–5.118)	0.026 *
	Lymphatic metastasis	4.518 (1.566–13.039)	0.005**
	Targeted therapy	0.100 (0.027–0.376)	0.001**
	PPFS	2.911 (1.290–6.569)	0.010 *
	PPST	14.701 (5.443–39.706)	P<0.001**

Notes: *Significant difference compared between-groups (p < 0.05). **Significant difference compared between-groups (p < 0.01). Antibacterials: Piperacillin sodium Tazobactam sodium (4.5 g).

Abbreviations: PPOT, postoperative pneumonia in 1–3 months; PPFS, postoperative pneumonia in 4–6 months; PPST, postoperative pneumonia in 7–12 month; LRO, lung cancer recurrence within one year; OR, odds ratio; CI, confidence interval; ICU, intensive care unit.

Figure 3 Nomogram was used for predicting the risk of LRO.

Abbreviations: PPFS, postoperative pneumonia in 4–6 months; PPST, postoperative pneumonia in 7–12.