Risk factors and prediction model construction of arrhythmia in elderly patients with early lung cancer after thoracoscopic pulmonary resection

doi:10.3760/cma.j.cn371439-20230802-00134

Abstract

Abstract:

Objective To investigate risk factors of arrhythmia in elderly patients with early lung cancer after thoracoscopic pulmonary resection to construct a prediction model. Methods Two hundreds and twenty elderly patients with early lung cancer after thoracoscopic pulmonary resection were retrospectively chosen in the period from January 2017 to January 2023 in Guang'an People's Hospital of Sichuan Province. The occurrence of arrhythmia was calculated， and the clinical data of patients with arrhythmia and those without arrhythmia were compared. Logistic regression was employeed to analyze the independent influencing factors of arrhythmia in elderly patients with early lung cancer after thoracoscopic pneumonectomy. Receiver operating characteristic （ROC） curve was used to evaluate the diagnostic performance of regression model on arrhythmia after thoracoscopic pneumonectomy in elderly patients with early lung cancer. Results Forty-one of 220 （18.64%） elderly patients with early lung cancer treated by thoracoscopic pneumonectomy had arrhythmia. There were statistically significant differences between patients with arrhythmia and patients without arrhythmia in age （χ²=17.76， P<0.001）， combined with essential hypertension （χ²=21.06， P<0.001）， forced expiratory volume in one second as a percentage of predicted value （FEV₁%）（χ²=17.88， P<0.001）， left atrium anterior-and-posterior diameter （χ²=37.82， P<0.001）， operation type （χ²=27.09， P<0.001） and postoperative constipation （χ²=18.25， P<0.001）. The results of multivariate analysis showed that age>75 years old （OR=22.17， 95%CI： 3.78-130.11， P=0.001）， combined with essential hypertension （OR=26.55， 95%CI： 3.99-176.95， P=0.001）， FEV₁%≤70% （OR=6.20， 95%CI： 1.37-28.11， P=0.018）， left atrium anterior-and-posterior diameter>40 mm （OR=10.84， 95%CI： 2.24-52.45， P=0.003）， thoracoscopic lobectomy （OR=7.07， 95%CI： 1.62-30.80， P=0.009）， and postoperative constipation （OR=79.97， 95%CI： 11.87-538.83， P<0.001） were all independent risk factors for arrhythmia after thoracoscopic pulmonary resection in elderly patients with early lung cancer. A prediction model was established for statistically significant indicators in multivariate analysis， ln（P/1-P）=-7.89+3.10×age+3.28×combined with essential hypertension+1.82×FEV₁%+2.38×left atrium anterior-and-posterior diameter+1.96×operation type+4.38×postoperative constipation （P was the prediction probability of P value in regression model）. ROC curve analysis showed that the area under the curve （AUC） of predict arrhythmia after thoracoscopic pulmonary resection in elderly patients with early lung cancer were 0.64， 0.71， 0.68， 0.74， 0.76， 0.87 and 0.98， respectively. The Yoden index was 27.29%， 42.28%， 34.92%， 47.42%， 73.63%， 50.97% and 91.97%， respectively. Conclusion Age>75 years old， combined with essential hypertension， FEV₁%≤70%， left atrium anterior-and-posterior diameter>40 mm， thoracoscopic lobectomy and postoperative constipation are all independent risk factors for arrhythmia after thoracoscopic pulmonary resection in elderly patients with early lung cancer. Nomogram model based on the above risk factors has high efficacy in predicting arrhythmia occurance after thoracoscopic pulmonary resection.

Key words: Lung neoplasms, Aged, Thoracoscopy, Pneumonectomy, Arrhythmias， cardiac

Zuo Xiaoping, Liu Xiaochuan, Wu Xiqiang, Li Zhou, Xia Tian, Liu Guofeng. Risk factors and prediction model construction of arrhythmia in elderly patients with early lung cancer after thoracoscopic pulmonary resection[J]. Journal of International Oncology, 2023, 50(12): 711-716.

Figures/Tables 4

References 19

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临床资料	心律失常（n=41）	无心律失常（n=179）	χ²/t值	P值
性别
男	23（56.10）	93（51.96）	0.23	0.632
女	18（43.90）	86（48.04）	0.23	0.632
年龄（岁）
60~75	25（60.98）	158（88.27）	17.76	<0.001
>75	16（39.02）	21（11.73）	17.76	<0.001
体质量指数（kg/m²）	22.08±3.70	22.31±3.86	-0.38	0.704
合并原发性高血压
是	15（36.59）	16（8.94）	21.06	<0.001
否	26（63.41）	163（91.06）	21.06	<0.001
合并糖尿病
是	9（21.95）	39（21.79）	<0.01	0.982
否	32（78.05）	140（78.21）	<0.01	0.982
吸烟指数（年支）
>400	25（60.98）	115（64.25）	0.15	0.695
≤400	16（39.02）	64（35.75）	0.15	0.695
FEV₁%（%）
≤70	26（63.41）	51（28.49）	17.88	<0.001
>70	15（36.59）	128（71.51）	17.88	<0.001
心率（次/min）	82.69±8.16	81.12±7.54	1.33	0.185
左心房前后径（mm）
>40	27（65.85）	33（18.44）	37.82	<0.001
≤40	14（34.15）	146（81.56）	37.82	<0.001
术式
胸腔镜肺叶切除术	23（56.10）	31（17.32）	27.09	<0.001
其他^a	18（43.90）	148（82.68）	27.09	<0.001
术后便秘
是	35（85.37）	87（48.60）	18.25	<0.001
否	6（14.63）	92（51.40）	18.25	<0.001
病理组织学类型
腺癌	15（36.59）	63（35.20）
鳞状细胞癌	23（56.10）	99（55.31）	0.20	0.906
小细胞癌	3（7.32）	17（9.50）
TNM分期
Ⅰ期	17（41.46）	75（41.90）	<0.01	0.959
Ⅱ期	24（58.54）	104（58.10）	<0.01	0.959
分化程度
高	9（21.95）	38（21.23）
中	25（60.98）	106（59.22）	0.13	0.936
低	7（17.07）	35（19.55）
淋巴结转移
是	16（39.02）	55（30.73）	1.05	0.305
否	25（60.98）	124（69.27）	1.05	0.305

因素	b值	SE值	Wald值	OR值	95%CI	P值
常量	-7.89	1.39	32.09	0.01		<0.001
年龄（>75岁/60~75岁）	3.10	0.90	11.78	22.17	3.78~130.11	0.001
合并原发性高血压（是/否）	3.28	0.97	11.48	26.55	3.99~176.95	0.001
FEV₁%（≤70%/>70%）	1.82	0.77	5.59	6.20	1.37~28.11	0.018
左心房前后径（>40 mm/≤40 mm）	2.38	0.80	8.78	10.84	2.24~52.45	0.003
术式（胸腔镜肺叶切除术/其他^a）	1.96	0.75	6.79	7.07	1.62~30.80	0.009
术后便秘（是/否）	4.38	0.97	20.26	79.97	11.87~538.83	<0.001

项目	AUC	敏感性（%）	特异性（%）	约登指数（%）
年龄	0.64	39.02	88.27	27.29
原发性高血压	0.71	51.22	91.06	42.28
FEV₁%	0.68	63.41	71.51	34.92
左心房前后径	0.74	65.85	81.56	47.42
术式	0.76	68.29	82.68	50.97
术后便秘	0.87	85.37	88.27	73.63
回归模型	0.98	97.56	94.41	91.97