Race-Specific versus Race-Neutral Pulmonary Function Predicted Values in Patients with Operable Lung Cancer

Rationale: Percent predicted forced expiratory volume in 1 second (FEV₁pp) is used for surgical risk assessment in patients with lung cancer. FEV₁pp is adjusted for race, despite concerns regarding inaccurate estimations of lung health. Objectives: To compare prediction of race-specific versus race-neutral FEV₁pp for pulmonary complications after lung cancer resection. Methods: Patients who underwent lung resection in the Society of Thoracic Surgeons General Thoracic Surgery Database were identified (2002-2008). We used Global Lung Initiative equations to derive race-specific and race-neutral FEV₁pp and compared their performance to predict pulmonary complications. Postoperative FEV₁pp was calculated with patients categorized into low- (>60%), intermediate- (30-60%), and high- (<30%) risk groups. Results: Of 24,276 patients, most were White (n = 21,130; 87.0%) or Black (n = 1,912; 7.9%). Race-specific equations reduced the mean FEV₁pp by 5.3% for White patients and increased it 6.2% for Black patients compared with race-neutral equations. Multivariate models using race-neutral FEV₁pp performed similarly to race-specific models in predicting pulmonary complications (sublobar resection: C-statistic 0.72; lobectomy: C-statistic 0.65; and bilobectomy/pneumonectomy: C-statistic 0.67; for both models) with similar adjusted odds ratios of FEV₁pp for both equation types. In 5,422 patients with calculable postoperative FEV₁pp, 617 (11.4%) were recategorized into a higher (n = 65) or lower (n = 552) risk group when using race-neutral equations. Of those moving into a lower-risk group, 98.0% were White. All patients reclassified into higher-risk groups were Black. Conclusions: Race-neutral FEV₁pp performed equally well as race-specific equations in predicting pulmonary complications and disentangled the effect of respiratory function from race on outcomes.