Abstract：
BACKGROUND: The effect of preoperative natural killer (NK) cell abnormalities on postoperative pulmonary complications (PPCs) after thoracoscopic radical resection of lung cancer is still unclear. The main purpose of this study was to investigate the relationship between the preoperative NK cell ratio and PPCs.
METHODS: The patients who underwent thoracoscopic radical resection for lung cancer were divided into a normal group and an abnormal group according to whether the proportion of preoperative NK cells was within the reference range. The main outcome was the incidence of PPCs during postoperative hospitalization. The demographic and perioperative data were collected. Propensity score matching was used to exclude systematic bias. Univariate logistic regression was used to test the relationship between the preoperative NK cell ratio and the incidence of PPCs. The restrictive cubic spline curve was used to analyze the dose-effect relationship between the preoperative NK cell ratio and the incidence of PPCs.
RESULTS: A total of 4161 patients were included. After establishing a matching cohort, 910 patients were included in the statistical analysis. The incidence of PPCs in the abnormal group was greater than that in the normal group (55.2% vs. 31.6%). The incidence of PPCs first decreased and then increased with increasing NK cell ratio. The proportion of patients with Grade 3 or higher PPCs in the normal group was lower than that in the abnormal group [108 (23.7%) vs. 223 (49%)]. The indwelling time of the thoracic drainage tube in the abnormal group was longer than that in the normal group [3 (3, 4) vs. 3 (3, 5)]. A preoperative abnormal NK cell ratio constituted a risk factor for PPCs in each subgroup.
CONCLUSIONS: Lung cancer patients with an abnormal proportion of peripheral blood NK cells before surgery were more likely to develop PPCs, their disease degree was more severe, and they had a prolonged duration of chest tube indwelling. Compared with those with abnormally high NK cell ratios, those with abnormally low NK cell ratios had more pronounced PPCs.
METHODS: The patients who underwent thoracoscopic radical resection for lung cancer were divided into a normal group and an abnormal group according to whether the proportion of preoperative NK cells was within the reference range. The main outcome was the incidence of PPCs during postoperative hospitalization. The demographic and perioperative data were collected. Propensity score matching was used to exclude systematic bias. Univariate logistic regression was used to test the relationship between the preoperative NK cell ratio and the incidence of PPCs. The restrictive cubic spline curve was used to analyze the dose-effect relationship between the preoperative NK cell ratio and the incidence of PPCs.
RESULTS: A total of 4161 patients were included. After establishing a matching cohort, 910 patients were included in the statistical analysis. The incidence of PPCs in the abnormal group was greater than that in the normal group (55.2% vs. 31.6%). The incidence of PPCs first decreased and then increased with increasing NK cell ratio. The proportion of patients with Grade 3 or higher PPCs in the normal group was lower than that in the abnormal group [108 (23.7%) vs. 223 (49%)]. The indwelling time of the thoracic drainage tube in the abnormal group was longer than that in the normal group [3 (3, 4) vs. 3 (3, 5)]. A preoperative abnormal NK cell ratio constituted a risk factor for PPCs in each subgroup.
CONCLUSIONS: Lung cancer patients with an abnormal proportion of peripheral blood NK cells before surgery were more likely to develop PPCs, their disease degree was more severe, and they had a prolonged duration of chest tube indwelling. Compared with those with abnormally high NK cell ratios, those with abnormally low NK cell ratios had more pronounced PPCs.
摘要：
背景：术前自然杀伤（NK）细胞异常对胸腔镜肺癌根治术后肺部并发症（PPCs）的影响尚不清楚。本研究的主要目的是探讨术前NK细胞比例与PPCs的关系。
方法：胸腔镜肺癌根治术患者根据术前NK细胞比例是否在参考范围内分为正常组和异常组。主要结果是术后住院期间PPC的发生率。收集人口统计学和围手术期数据。倾向评分匹配用于排除系统偏差。单因素logistic回归分析术前NK细胞比例与PPC发生率的关系。采用限制性三次样条曲线分析术前NK细胞比例与PPC发生率的量效关系。
结果：共纳入4161例患者。建立匹配队列后，910例患者纳入统计分析。异常组PPC的发生率大于正常组（55.2％vs.31.6%）。随着NK细胞比例的增加，PPC的发生率先降低后升高。正常组中3级或更高PPC的患者比例低于异常组[108（23.7％）vs.223（49%）]。异常组胸腔引流管留置时间长于正常组[3(3,4)vs.3(3,5)].术前异常的NK细胞比率构成了每个亚组中PPC的危险因素。
结论：术前外周血NK细胞比例异常的肺癌患者更容易发生PPCs，他们的疾病程度更严重，他们的胸管留置时间延长。与NK细胞比例异常高的人相比，NK细胞比率异常低的患者的PPC更为明显.
方法：胸腔镜肺癌根治术患者根据术前NK细胞比例是否在参考范围内分为正常组和异常组。主要结果是术后住院期间PPC的发生率。收集人口统计学和围手术期数据。倾向评分匹配用于排除系统偏差。单因素logistic回归分析术前NK细胞比例与PPC发生率的关系。采用限制性三次样条曲线分析术前NK细胞比例与PPC发生率的量效关系。
结果：共纳入4161例患者。建立匹配队列后，910例患者纳入统计分析。异常组PPC的发生率大于正常组（55.2％vs.31.6%）。随着NK细胞比例的增加，PPC的发生率先降低后升高。正常组中3级或更高PPC的患者比例低于异常组[108（23.7％）vs.223（49%）]。异常组胸腔引流管留置时间长于正常组[3(3,4)vs.3(3,5)].术前异常的NK细胞比率构成了每个亚组中PPC的危险因素。
结论：术前外周血NK细胞比例异常的肺癌患者更容易发生PPCs，他们的疾病程度更严重，他们的胸管留置时间延长。与NK细胞比例异常高的人相比，NK细胞比率异常低的患者的PPC更为明显.
