Thoracic Revised Cardiac Risk Index Is Associated With Prognosis After Resection for Stage I Lung Cancer

The objective of this investigation is to evaluate whether the Thoracic Revised Cardiac Risk Index (ThRCRI) is an independent prognostic factor after lung resection for early-stage lung cancer.

Observational analysis performed on 1,370 patients (from 2000 to 2011) undergoing anatomic lung resection for pathologic stage I non-small cell lung cancer in three thoracic surgery units. Survival was calculated by the Kaplan-Meier method. The association between survival and several clinical variables was determined by Cox multivariate analysis.

Median follow-up was 77 months. Patients were assigned to risk classes according to their ThRCRI score: class A (score, 0 to 1), 1,062 patients; class B (score, 1.5 to 2.5), 284 patients; class C (score, >2.5), 24 patients. Patients in class A had a longer 5-year overall survival (66%) compared w those in classes B (53%) and C (35%; log-rank test, p < 0.0001). The ThRCRI remained an independent prognostic factor after Cox regression analysis (hazard ratio, 1.2; p = 0.001) along with age (hazard ratio, 1.03; p < 0.0001), pT stage (hazard ratio, 1.6; p < 0.0001), and forced expiratory volume in 1 second (hazard ratio, 0.98; p < 0.0001). Five-year cancer-specific survival was longer in patients with ThRCRI class A (77%) compared with classes B (75%) and C (55%; log-rank test, p = 0.05). Mortality from cardiac events occurring during follow-up was 1.5% in class A, 7% in class B, and 13% in class C (p < 0.0001).

The ThRCRI is a useful prognostic score in patients undergoing resection for early-stage lung cancer. Patients with a score greater than 2.5 should be counseled about their increased risk of major perioperative cardiac events and their expected decreased long-term survival.