Prediction significance of VE/VCO2 slope for persistent air leakage after video-assisted thoracoscopic surgery in non-small cell lung cancer

doi:10.3877/cma.j.issn.1674-6902.2025.06.012

Abstract

Abstract:

Objective

To investigate the predictive significance of ventilatory efficiency [the slope of minute ventilation (VE) to carbon dioxide output (VCO₂)] for prolonged air leak (PAL) after video-assisted thoracoscopic surgery (VATS) in patients with non-small cell lung cancer (NSCLC).

Methods

A retrospective selection was made of 82 NSCLC patients who underwent video-assisted thoracoscopic anatomic lung resection in our hospital from March 2022 to August 2024. Based on the occurrence of postoperative PAL, patients were divided into two groups: 15 patients with PAL constituted the observation group, and 67 patients without PAL constituted the control group. Preoperative pulmonary function tests and cardiopulmonary exercise testing (CPET) were performed, and the VE/VCO₂ slope was recorded.

Results

The VE/VCO₂ slope in the observation group was 32.00 (28.00, 35.00), which was higher than that in the control group [27.00 (24.00, 31.00)](P<0.05). The area under the receiver operating characteristic (ROC) curve (AUC) for the VE/VCO₂ slope predicting PAL was 0.833 (95%CI: 0.731~0.936), with a cutoff value of 31.5, a sensitivity of 80.00%, and a specificity of 79.10%. Logistic regression analysis showed that smoking history [OR(95%CI): 8.006 (1.013~63.279)], percentage of forced expiratory volume in one second in predicted value (FEV₁%) [OR(95%CI): 0.088 (0.009~0.864)], pleural adhesion [OR(95%CI): 10.366 (1.225~87.752)], and VE/VCO₂ slope [OR(95%CI): 28.889(3.851~216.729)] were risk factors for PAL(P<0.05). ROC curve analysis showed that the nomogram model for predicting the risk of postoperative PAL had an AUC of 0.914 (95%CI: 0.851~0.977), with a sensitivity and specificity of 93.30% and 74.60%, respectively. The Hosmer-Lemeshow goodness-of-fit test indicated a good fit (χ²=0.992, P=0.986). Clinical decision curve analysis showed a good net clinical benefit for predicting postoperative PAL when the high-risk threshold was between 0.03 and 0.82.

Conclusion

Ventilatory efficiency (VE/VCO₂ slope) is associated with an increased risk of PAL after VATS in NSCLC patients. A higher VE/VCO₂ slope indicates lower ventilatory efficiency and a higher risk of postoperative PAL.

Key words: Non-small cell lung cancer, Video-assisted thoracoscopic surgery, Ventilation efficiency, Prolonged air leak

Xiaoqiang Wang, Yuman Sun, Xuan Zheng, Xinxin Zhao, Jingjing Zheng. Prediction significance of VE/VCO₂ slope for persistent air leakage after video-assisted thoracoscopic surgery in non-small cell lung cancer[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2025, 18(06): 923-928.

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Figures/Tables 3

References 32

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临床资料	观察组(n＝15)	对照组(n＝67)	t/χ²/Z值	P值
吸烟史[n(%)]	5(33.33)	8(11.94)	4.205	0.040
合并症[n(%)]
高血压	4(26.67)	24(35.82)	0.457	0.499
糖尿病	4(26.67)	10(14.93)	1.193	0.275
冠心病	2(13.33)	7(10.45)	0.104	0.747
病理亚型[n(%)]			1.212	0.546
肺腺癌	6(40.0)	34(50.75)
肺鳞癌	6(40.0)	26(38.81)
其他	3(20.0)	7(10.45)
TNM分期[n(%)]			0.025	0.875
ⅠB-Ⅱ期	13(86.67)	57(85.07)
ⅢA-ⅢB期	2(13.33)	10(14.93)
ASA评分[n(%)]			2.267	0.132
Ⅰ级	8(53.33)	49(73.13)
Ⅱ级	7(46.67)	18(26.87)
手术类型[n(%)]			1.140	0.565
楔形切除术	3(20.0)	16(23.88)
肺叶切除术	12(80.0)	47(70.15)
肺节段切除术	0(0.0)	4(5.97)
VATS手术方式[n(%)]			2.549	0.110
单孔法	13(86.67)	44(65.67)
双孔/三孔法	2(13.33)	23(34.33)
根治性(R0)切除[n(%)]	14(93.33)	61(91.04)	0.082	0.774
肺功能(±s)
FEV₁%(%)	86.13±17.29	98.14±17.55	2.402	0.019
FVC%(%)	96.47±12.36	103.36±16.19	1.547	0.126
FEV₁/FVC	0.74±0.12	0.75±0.08	0.396	0.693
DLCO%(%)	98.40±27.63	96.31±20.50	0.334	0.739

临床资料	观察组(n＝15)	对照组(n＝67)	t/χ²/Z值	P值
吸烟史[n(%)]	5(33.33)	8(11.94)	4.205	0.040
合并症[n(%)]
高血压	4(26.67)	24(35.82)	0.457	0.499
糖尿病	4(26.67)	10(14.93)	1.193	0.275
冠心病	2(13.33)	7(10.45)	0.104	0.747
病理亚型[n(%)]			1.212	0.546
肺腺癌	6(40.0)	34(50.75)
肺鳞癌	6(40.0)	26(38.81)
其他	3(20.0)	7(10.45)
TNM分期[n(%)]			0.025	0.875
ⅠB-Ⅱ期	13(86.67)	57(85.07)
ⅢA-ⅢB期	2(13.33)	10(14.93)
ASA评分[n(%)]			2.267	0.132
Ⅰ级	8(53.33)	49(73.13)
Ⅱ级	7(46.67)	18(26.87)
手术类型[n(%)]			1.140	0.565
楔形切除术	3(20.0)	16(23.88)
肺叶切除术	12(80.0)	47(70.15)
肺节段切除术	0(0.0)	4(5.97)
VATS手术方式[n(%)]			2.549	0.110
单孔法	13(86.67)	44(65.67)
双孔/三孔法	2(13.33)	23(34.33)
根治性(R0)切除[n(%)]	14(93.33)	61(91.04)	0.082	0.774
肺功能(±s)
FEV₁%(%)	86.13±17.29	98.14±17.55	2.402	0.019
FVC%(%)	96.47±12.36	103.36±16.19	1.547	0.126
FEV₁/FVC	0.74±0.12	0.75±0.08	0.396	0.693
DLCO%(%)	98.40±27.63	96.31±20.50	0.334	0.739

CPET指标	观察组(n＝15)	对照组(n＝67)	t/Z值	P值
静息时
PaO₂(kPa)	10.20±0.76	10.68±1.27	1.404	0.164
PaCO₂(kPa)	4.58±0.45	4.62±0.45	0.311	0.757
pH	7.44±0.02	7.45±0.03	1.228	0.223
VO₂(ml/kg^－1·min^－1)	4.00(3.30，4.60)	4.50(3.60，5.10)	－0.336	0.737
VCO₂(L/min)	0.28(0.24，0.37)	0.28(0.21，0.40)	－0.901	0.368
RER	0.87(0.81，0.90)	0.82(0.78，0.89)	－0.636	0.525
VO₂/HR(ml/beat)	4.10(3.10，5.20)	4.40(3.40，6.10)	－0.450	0.653
VE(L/min)	13.00±4.79	11.70±3.36	1.247	0.216
VT(L)	0.69±0.24	0.66±0.19	0.526	0.600
Fb(bpm)	18.80±2.96	18.45±4.06	0.315	0.754
VD/VT	0.31±0.06	0.34±0.07	1.536	0.128
ETCO₂(mmHg)	29.00(25.00，31.00)	31.00(29.00，33.00)	－1.449	0.147
峰值运动时
PaO₂(kPa)	11.26±1.78	12.07±1.95	1.476	0.144
PaCO₂(kPa)	4.68±0.69	4.66±0.51	0.128	0.898
pH	7.34±0.04	7.35±0.04	0.875	0.384
VO₂(ml/kg^－1·min^－1)	17.50(14.80，19.30)	18.80(15.70，22.70)	－1.230	0.219
VCO₂(L/min)	1.69(1.35，1.89)	1.77(1.42，2.06)	－1.535	0.125
RER	1.10(1.04，1.14)	1.18(1.12，1.23)	－1.449	0.147
VO₂/HR(ml/beat)	11.00(9.40，12.90)	10.60(8.80，12.40)	－0.450	0.652
VE(L/min)	60.34±15.70	60.97±17.52	0.128	0.898
VT(L)	1.88±0.54	1.98±0.59	0.602	0.549
Fb(bpm)	32.53±5.04	31.61±5.90	0.559	0.578
VD/VT	0.24±0.07	0.22±0.05	1.296	0.199
ETCO₂(mmHg)	34.00(31.00，37.00)	37.00(33.00，40.00)	－2.755	0.006
VE/VCO₂斜率	32.00(28.00，35.00)	27.00(24.00，31.00)	－4.031	0.000

CPET指标	观察组(n＝15)	对照组(n＝67)	t/Z值	P值
静息时
PaO₂(kPa)	10.20±0.76	10.68±1.27	1.404	0.164
PaCO₂(kPa)	4.58±0.45	4.62±0.45	0.311	0.757
pH	7.44±0.02	7.45±0.03	1.228	0.223
VO₂(ml/kg^－1·min^－1)	4.00(3.30，4.60)	4.50(3.60，5.10)	－0.336	0.737
VCO₂(L/min)	0.28(0.24，0.37)	0.28(0.21，0.40)	－0.901	0.368
RER	0.87(0.81，0.90)	0.82(0.78，0.89)	－0.636	0.525
VO₂/HR(ml/beat)	4.10(3.10，5.20)	4.40(3.40，6.10)	－0.450	0.653
VE(L/min)	13.00±4.79	11.70±3.36	1.247	0.216
VT(L)	0.69±0.24	0.66±0.19	0.526	0.600
Fb(bpm)	18.80±2.96	18.45±4.06	0.315	0.754
VD/VT	0.31±0.06	0.34±0.07	1.536	0.128
ETCO₂(mmHg)	29.00(25.00，31.00)	31.00(29.00，33.00)	－1.449	0.147
峰值运动时
PaO₂(kPa)	11.26±1.78	12.07±1.95	1.476	0.144
PaCO₂(kPa)	4.68±0.69	4.66±0.51	0.128	0.898
pH	7.34±0.04	7.35±0.04	0.875	0.384
VO₂(ml/kg^－1·min^－1)	17.50(14.80，19.30)	18.80(15.70，22.70)	－1.230	0.219
VCO₂(L/min)	1.69(1.35，1.89)	1.77(1.42，2.06)	－1.535	0.125
RER	1.10(1.04，1.14)	1.18(1.12，1.23)	－1.449	0.147
VO₂/HR(ml/beat)	11.00(9.40，12.90)	10.60(8.80，12.40)	－0.450	0.652
VE(L/min)	60.34±15.70	60.97±17.52	0.128	0.898
VT(L)	1.88±0.54	1.98±0.59	0.602	0.549
Fb(bpm)	32.53±5.04	31.61±5.90	0.559	0.578
VD/VT	0.24±0.07	0.22±0.05	1.296	0.199
ETCO₂(mmHg)	34.00(31.00，37.00)	37.00(33.00，40.00)	－2.755	0.006
VE/VCO₂斜率	32.00(28.00，35.00)	27.00(24.00，31.00)	－4.031	0.000

自变量	B	SE(B)	Walds值	OR(95%CI)	P值
吸烟史	2.080	1.055	3.889	8.006(1.013~63.279)	0.049
FEV₁%	－2.425	1.163	4.349	0.088(0.009~0.864)	0.037
胸膜黏连	2.339	1.090	4.605	10.366(1.225~87.752)	0.032
峰值ETCO₂	－0.890	0.843	1.116	0.411(0.079~2.141)	0.291
VE/VCO₂斜率	3.363	1.028	10.701	28.889(3.851~216.729)	0.001

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Prediction significance of VE/VCO₂ slope for persistent air leakage after video-assisted thoracoscopic surgery in non-small cell lung cancer

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