基于肺叶特异性淋巴结转移模式的选择性淋巴结清扫对可切除非小细胞肺癌患者生存结局的影响：应用倾向评分的大规模回顾性队列研究

Effect of selective lymph node dissection based on patterns of lobe-specific lymph node metastases on patient outcome in patients with resectable non-small cell lung cancer: a large-scale retrospective cohort study applying a propensity score.

机构信息

Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya 461-8681, Japan.

出版信息

J Thorac Cardiovasc Surg. 2010 Apr;139(4):1001-6. doi: 10.1016/j.jtcvs.2009.07.024. Epub 2009 Sep 5.

DOI:10.1016/j.jtcvs.2009.07.024

PMID:19733863

Abstract

OBJECTIVE

Lobectomy with systematic complete mediastinal lymph node dissection is standard surgical treatment for localized non-small cell lung cancer. However, selective mediastinal lymph node dissection based on lobe-specific metastases (selective dissection) has often been performed. This study was designed to evaluate the validity of the selective lymph node dissection.

METHODS

From 1995 through 2003, 625 patients in our hospital had surgery for complete mediastinal lymph node dissection and 147 for selective dissection. We evaluated whether selective dissection adversely affected overall survival. To minimize possible biases due to confounding by treatment indication, we performed a retrospective cohort analysis by applying a propensity score. The propensity score was calculated by logistic regression based on 15 factors available that were potentially associated with treatment indication. Patients were divided into 4 groups according to quartile, and comparison between selective dissection and complete mediastinal lymph node dissection was made using propensity score quartile-stratified Cox proportional hazard models.

RESULTS

Comparison of baseline characteristics between patients having selective dissection and patients having complete mediastinal lymph node dissection according to propensity score quartile supported comparability of the 2 groups. The 5-year overall survival rates were 76.0% for selective dissection versus 71.9% for complete mediastinal lymph node dissection. The 5-year survival probabilities stratified by propensity score quartile consistently showed no marked difference. In multivariate models, there was no significant difference between the 2 groups (hazard ratio = 1.17, P = .500) as also seen in the analysis without propensity score (hazard ratio = 1.06; 95% confidence interval, 0.68-1.64; P = .810). Therefore, selective dissection showed no significant impact on poor survival compared with complete mediastinal lymph node dissection.

CONCLUSIONS

Selective lymph node dissection did not worsen the survival of patients with non-small cell lung cancer.

摘要

目的

肺叶切除术联合系统全面纵隔淋巴结清扫术是局部非小细胞肺癌的标准外科治疗方法。然而，经常采用基于肺叶特异性转移的选择性纵隔淋巴结清扫术（选择性清扫）。本研究旨在评估选择性淋巴结清扫术的有效性。

方法

1995 年至 2003 年，我院 625 例患者行全纵隔淋巴结清扫术，147 例患者行选择性清扫术。我们评估了选择性清扫术是否会对总生存产生不利影响。为了尽量减少因治疗适应证混杂引起的偏倚，我们通过应用倾向评分进行回顾性队列分析。倾向评分通过基于 15 个可能与治疗适应证相关的因素的逻辑回归计算得出。患者根据四分位数分为 4 组，并使用倾向评分四分位分层 Cox 比例风险模型比较选择性清扫术和全纵隔淋巴结清扫术。

结果

根据倾向评分四分位数对选择性清扫术患者和全纵隔淋巴结清扫术患者的基线特征进行比较，支持两组之间的可比性。选择性清扫术的 5 年总生存率为 76.0%，全纵隔淋巴结清扫术为 71.9%。根据倾向评分四分位数分层的 5 年生存率概率始终没有明显差异。多变量模型中，两组之间无显著差异（风险比=1.17，P=.500），无倾向评分分析中也无显著差异（风险比=1.06；95%置信区间，0.68-1.64；P=.810）。因此，与全纵隔淋巴结清扫术相比，选择性清扫术对非小细胞肺癌患者的不良生存无显著影响。