A Predictive Model for 90-Day Mortality After Lobectomy in Patients with Non-Small Cell Lung Cancer: A Multicenter Retrospective Study

ORIGINAL ARTICLE
Andrey E. Slugin, Evgeny A. Toneev, Sergei Y. Pushkin, Maxim S. Rudenko, Egor V. Cherrnetsov, Anton S. Ognev, Valeria V. Nemtseva

 
For citation: Slugin AE, Toneev EA, Pushkin SY, Rudenko MS, Cherrnetsov EV, Ognev AS, Nemtseva VV. A Predictive Model for 90-Day Mortality After Lobectomy in Patients with Non-Small Cell Lung Cancer: A Multicenter Retrospective Study. International Journal of Biomedicine. 2025;15(3):505-510. doi:10.21103/Article15(3)_OA7
 
Originally published September 5, 2025

Abstract: 

Background: Over the past decade, multiple prognostic models have been developed to estimate short-term (including in-hospital) mortality following lobectomy. However, 90-day postoperative mortality is not as widely used as a standard measure for evaluating outcomes after lobectomy. The objective of this study was to evaluate 90-day mortality following lobectomy with mediastinal lymphadenectomy for non-small cell lung cancer (NSCLC), and to identify factors independently associated with this outcome.
Methods and Results: This retrospective multicenter study included data from 700 patients who underwent anatomical lobectomy with systematic mediastinal lymphadenectomy for histologically confirmed NSCLC. A clinically homogeneous cohort was formed to validate the assessment of intra- and postoperative risk factors associated with 90-day mortality.
Among 700 patients included in the study, the 90-day postoperative mortality rate was 3.7%. Multivariate logistic regression identified the following independent predictors of 90-day mortality: prolonged air leak (AOR=2.505; 95% CI: 1.115–5.629, P=0.026), intraoperative blood loss (AOR=1.003; 95% CI: 1.001–1.005, P=0.004), and forced expiratory volume in one second (AOR=0.965; 95% CI: 0.945–0.985, P=0.001). To assess the relationship between the probability of 90-day postoperative mortality and the value of the logistic function P, a ROC analysis was performed. The area under the ROC curve (AUC) was 0.719 (95% CI: 0.606–0.832; P<0.001). The sensitivity and specificity of the resulting predictive model were 65.4% and 77.1%, respectively.
Conclusion: The proposed model incorporating three key clinical variables may serve as a practical tool for postoperative risk stratification and guiding follow-up strategies in patients undergoing lobectomy for NSCLC.

Keywords: 
lung cancer • lobectomy • 90-day mortality • predictive model • nomogram
References: 
  1. Montagne F, Guisier F, Venissac N, Baste JM. The Role of Surgery in Lung Cancer Treatment: Present Indications and Future Perspectives-State of the Art. Cancers (Basel). 2021 Jul 23;13(15):3711. doi: 10.3390/cancers13153711. PMID: 34359612; PMCID: PMC8345199.
  2. McMillan RR, Berger A, Sima CS, Lou F, Dycoco J, Rusch V, Rizk NP, Jones DR, Huang J. Thirty-day mortality underestimates the risk of early death after major resections for thoracic malignancies. Ann Thorac Surg. 2014 Nov;98(5):1769-74; discussion 1774-5. doi: 10.1016/j.athoracsur.2014.06.024. Epub 2014 Sep 8. PMID: 25200731; PMCID: PMC4410352.
  3. Damhuis RA, Wijnhoven BP, Plaisier PW, Kirkels WJ, Kranse R, van Lanschot JJ. Comparison of 30-day, 90-day and in-hospital postoperative mortality for eight different cancer types. Br J Surg. 2012 Aug;99(8):1149-54. doi: 10.1002/bjs.8813. Epub 2012 Jun 20. PMID: 22718521.
  4. Toneev EA, Komarov AS, Midlenko OV, et al. [Predictive models for assessing the risk of postoperative cardiac and respiratory complications in patients with lung cancer]. Ulyanovsk Medical and Biological Journal. 2024;(1):41–63. doi:10.34014/2227-1848-2024-1-41-63. [Article in Russian].
  5. Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, Postmus PE, Rusch V, Sobin L; International Association for the Study of Lung Cancer International Staging Committee; Participating Institutions. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol. 2007 Aug;2(8):706-14. doi: 10.1097/JTO.0b013e31812f3c1a. Erratum in: J Thorac Oncol. 2007 Oct;2(10):985. PMID: 17762336.
  6. Pompili C, Falcoz PE, Salati M, Szanto Z, Brunelli A. A risk score to predict the incidence of prolonged air leak after video-assisted thoracoscopic lobectomy: An analysis from the European Society of Thoracic Surgeons database. J Thorac Cardiovasc Surg. 2017 Apr;153(4):957-965. doi: 10.1016/j.jtcvs.2016.11.064. Epub 2016 Dec 22. PMID: 28089646.
  7. Seely AJ, Ivanovic J, Threader J, Al-Hussaini A, Al-Shehab D, Ramsay T, Gilbert S, Maziak DE, Shamji FM, Sundaresan RS. Systematic classification of morbidity and mortality after thoracic surgery. Ann Thorac Surg. 2010 Sep;90(3):936-42; discussion 942. doi: 10.1016/j.athoracsur.2010.05.014. PMID: 20732521.
  8. Pezzi CM, Mallin K, Mendez AS, Greer Gay E, Putnam JB Jr. Ninety-day mortality after resection for lung cancer is nearly double 30-day mortality. J Thorac Cardiovasc Surg. 2014 Nov;148(5):2269-77. doi: 10.1016/j.jtcvs.2014.07.077. Epub 2014 Aug 4. PMID: 25172318.
  9. Soldath P, Ryom P, Petersen RH. Long-term survival after sleeve lobectomy versus pneumonectomy for non-small cell lung cancer. Surg Oncol. 2025 Feb;58:102168. doi: 10.1016/j.suronc.2024.102168. Epub 2024 Nov 28. PMID: 39622154.
  10. Gooseman MR, Brunelli A, Chaudhuri N, Milton R, Tcherveniakov P, Papagiannopoulos K, Valuckiene L. Prolonged air leak after segmentectomy: incidence and risk factors. J Thorac Dis. 2023 Feb 28;15(2):858-865. doi: 10.21037/jtd-22-623. Epub 2022 Oct 17. PMID: 36910087; PMCID: PMC9992634.
  11. Ma S, Li F, Li J, Wang L, Song H. Risk factor analysis and nomogram prediction model construction of postoperative complications of thoracoscopic non-small cell lung cancer. J Thorac Dis. 2024 Jun 30;16(6):3655-3667. doi: 10.21037/jtd-24-113. Epub 2024 Jun 12. PMID: 38983183; PMCID: PMC11228728.
  12. Yao L, Wang W. Effect of intraoperative blood loss on postoperative pulmonary complications in patients undergoing video-assisted thoracoscopic surgery. Turk Gogus Kalp Damar Cerrahisi Derg. 2021 Jul 26;29(3):347-353. doi: 10.5606/tgkdc.dergisi.2021.20657. PMID: 34589253; PMCID: PMC8462118.
  13. Halldorsson H, Orrason AW, Oskarsdottir GN, Petursdottir A, Fridriksson BM, Magnusson MK, Jonsson S, Gudbjartsson T. Improved long-term survival following pulmonary resections for non-small cell lung cancer: results of a nationwide study from Iceland. Ann Transl Med. 2019 Mar;7(5):88. doi: 10.21037/atm.2019.01.10. PMID: 31019938; PMCID: PMC6462663.
  14. Taylor M, Hashmi SF, Martin GP, Shackcloth M, Shah R, Booton R, Grant SW. A systematic review of risk prediction models for perioperative mortality after thoracic surgery. Interact Cardiovasc Thorac Surg. 2021 Apr 8;32(3):333-342. doi: 10.1093/icvts/ivaa273. PMID: 33257987; PMCID: PMC8906726.
  15. Powell HA, Tata LJ, Baldwin DR, Stanley RA, Khakwani A, Hubbard RB. Early mortality after surgical resection for lung cancer: an analysis of the English National Lung cancer audit. Thorax. 2013 Sep;68(9):826-34. doi: 10.1136/thoraxjnl-2012-203123. Epub 2013 May 17. PMID: 23687050.
  16. Brunelli A, Dinesh P, Woodcock-Shaw J, Littlechild D, Pompili C. Ninety-Day Mortality After Video-Assisted Thoracoscopic Lobectomy: Incidence and Risk Factors. Ann Thorac Surg. 2017 Sep;104(3):1020-1026. doi: 10.1016/j.athoracsur.2017.02.083. Epub 2017 Jun 1. PMID: 28577845.
  17. Taylor M, Martin GP, Abah U, Sperrin M, Smith M, Bhullar D, Shackcloth M, Woolley S, West D, Shah R, Grant SW; North West Thoracic Surgery Collaborative (NWTSC). Development and internal validation of a clinical prediction model for 90-day mortality after lung resection: the RESECT-90 score. Interact Cardiovasc Thorac Surg. 2021 Nov 22;33(6):921-927. doi: 10.1093/icvts/ivab200. PMID: 34324664; PMCID: PMC8632783.
  18. Zhou Q, Huang J, Pan F, Li J, Liu Y, Hou Y, Song W, Luo Q. Operative outcomes and long-term survival of robotic-assisted segmentectomy for stage IA lung cancer compared with video-assisted thoracoscopic segmentectomy. Transl Lung Cancer Res. 2020 Apr;9(2):306-315. doi: 10.21037/tlcr-20-533. PMID: 32420070; PMCID: PMC7225141.
  19. Gao SJ, Jin L, Meadows HW, Shafman TD, Gross CP, Yu JB, Aerts HJWL, Miccio JA, Stahl JM, Mak RH, Decker RH, Kann BH. Prediction of Distant Metastases After Stereotactic Body Radiation Therapy for Early Stage NSCLC: Development and External Validation of a Multi-Institutional Model. J Thorac Oncol. 2023 Mar;18(3):339-349. doi: 10.1016/j.jtho.2022.11.007. Epub 2022 Nov 15. PMID: 36396062.
  20. Smith H, Li H, Brandts-Longtin O, Yeung C, Maziak D, Gilbert S, Villeneuve PJ, Sundaresan S, Passman R, Shamji F, Seely AJE. External validity of a model to predict postoperative atrial fibrillation after thoracic surgery. Eur J Cardiothorac Surg. 2020 May 1;57(5):874-880. doi: 10.1093/ejcts/ezz341. PMID: 31845993.
  21. Shen KR, Edwards J, Jaklitsch MT, Steliga MA, Daniel TM. Effectiveness of surgical sealants in reducing pulmonary air leaks: A meta-analysis. Journal of Thoracic Disease. 2021;13(1):120–130. doi: 10.21037/jtd-20-2366
  22. Toneev EA, Bazarov DV, Pikin OV, Charyshkin AL, Martynov AA, Lisyutin RI, Zul’karnyaev ASh, Anokhina EP. [Prolonged air leak after lobectomy in lung cancer patients]. Siberian Journal of Oncology. 2020;19(1):103-110. doi: 10.21294/1814-4861-2020-19-1-103-110. [Article in Russian].
  23. Shiono S, Abiko M, Okazaki T, Kaseda K, Maeda H. Risk factors for prolonged air leak after lung cancer surgery and its impact on long-term outcomes. Journal of Thoracic Disease. 2021;13(6):3562–3570. doi:10.21037/jtd-20-3352

Download Article
Received July 9, 2025.
Accepted August 19, 2025.
©2025 International Medical Research and Development Corporation.