Nakajima Jun, Sato Hajime, Takamoto Shinichi
Department of Cardiothoracic Surgery, Graduate School of Medicine, University of Tokyo, Japan.
Chest. 2005 Nov;128(5):3512-8. doi: 10.1378/chest.128.5.3512.
Our aim was to clarify the hypothesis that the postsurgical prognosis of patients with non-small cell lung cancer (NSCLC) proven by preoperative diagnostic transbronchial biopsy (TBLB) was worse than that of the patients with NSCLC determined at the time of surgery.
We entered the propensity score as a continuous variable in the Cox proportional hazards model, along with the success/failure of TBLB and other covariates that were adjusted for the bias inherent to the success/failure of the TBLB examination.
Five hundred ninety-nine consecutive patients with NSCLC undergoing complete resection were divided into two groups. Pathologic diagnosis by TBLB was preoperatively determined in patients belonging to group 1 (n = 367). TBLB was unsuccessful and exploratory thoracotomy or thoracoscopy was followed by surgical resection in patients belonging to group 2 (n = 232). The overall recurrence-free survival rate was examined as the surgical outcomes.
The postsurgical recurrence-free rate was significantly higher in group 2 than in group 1. Group 2 patients showed better prognosis than group 1 patients, even when the data between the two groups were adjusted by propensity score. When the groups were subdivided by the pathologic stage of disease, the subgroup consisting of group 2 patients with stage IA and IB lung cancer still showed a higher recurrence-free rate than those in group 1 by propensity score analysis.
The postsurgical prognosis of the patients with NSCLC was significantly better if the preoperative TBLB was unsuccessful. This result suggested that advanced NSCLC had a tendency to be diagnosed with TBLB and, possibly, that the TBLB procedure might worsen the prognosis of patients with resectable NSCLC. We suggest that intraoperative diagnosis followed by the consecutive resection of NSCLC may be beneficial for improving the surgical outcomes of NSCLC patients.
我们的目的是阐明以下假设，即经术前诊断性经支气管活检（TBLB）确诊的非小细胞肺癌（NSCLC）患者的术后预后比手术时确诊的NSCLC患者更差。
我们将倾向评分作为连续变量纳入Cox比例风险模型，同时纳入TBLB的成功/失败情况以及其他协变量，以校正TBLB检查成功/失败所固有的偏差。
599例连续接受完全切除的NSCLC患者被分为两组。第1组（n = 367）患者术前通过TBLB进行病理诊断。第2组（n = 232）患者TBLB未成功，随后行 exploratory thoracotomy（开胸探查术）或胸腔镜检查，然后进行手术切除。将总体无复发生存率作为手术结果进行检查。
第2组的术后无复发生存率显著高于第1组。即使通过倾向评分对两组数据进行校正，第2组患者的预后仍优于第1组患者。当根据疾病的病理分期对两组进行细分时，通过倾向评分分析，第2组中IA期和IB期肺癌患者亚组的无复发生存率仍高于第1组。
如果术前TBLB未成功，NSCLC患者的术后预后明显更好。这一结果表明，晚期NSCLC倾向于通过TBLB被诊断出来，并且，可能TBLB操作可能会使可切除NSCLC患者的预后恶化。我们建议，NSCLC术中诊断后连续切除可能有利于改善NSCLC患者的手术结果。
