Section of Thoracic Surgery, Department of Therapeutic Radiology and Radiation Oncology, Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Comprehensive Cancer Center, Yale School of Medicine, Yale University, New Haven, Connecticut 06520, USA.
Ann Thorac Surg. 2012 Sep;94(3):895-901. doi: 10.1016/j.athoracsur.2012.04.091. Epub 2012 Jul 25.
Racial disparities in access to surgical resection for treatment of early-stage non-small-cell lung cancer (NSCLC) are well documented. However it is unclear how race, clinical, and hospital characteristics affect the surgical approach among patients undergoing resection.
Using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER)/Medicare linked database, we identified patients 67 years of age or older diagnosed with stage I NSCLC who underwent surgical resection from 2000 to 2007. Surgical approach was categorized as lobectomy or segmentectomy (anatomic) versus wedge resection (nonanatomic). We used logistic regression to identify the association between demographic, clinical, and hospital factors and the use of nonanatomic resections.
There were 8,986 patients in the sample (mean age, 75 years; 53% women); 12.8% underwent nonanatomic resection. The use of nonanatomic resection increased significantly, from 11.0% in 2000 to 15.9% in 2007 (p=0.008). In multivariable analysis, race was not associated with the receipt of nonanatomic resection. Factors associated with the use of nonanatomic resections included age greater than 80 years (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.15-1.98), T1a primary tumor status, chronic obstructive pulmonary disease (COPD) (OR, 1.81; 95% CI, 1.55-2.12), and volume of hospital lung resections performed (highest versus lowest hospital volume, OR, 1.58; 95% CI, 1.23-2.04). More nonanatomic resections were performed in 2007 than in 2000 (OR, 1.73; 95% CI, 1.27-2.37). After stratifying by tumor size, the temporal trend in the use of nonanatomic resection remained significant only among patients with tumors greater than 3 cm.
Since 2000, the use of nonanatomic resections in stage I NSCLC has increased, most significantly among patients with larger tumors. After adjusting for clinical factors, there was no relation between race and type of surgical resection.
在获得外科切除手术治疗早期非小细胞肺癌（NSCLC）方面，种族差异已得到充分证实。然而，种族、临床和医院特征如何影响接受切除术的患者的手术方法尚不清楚。
利用美国国家癌症研究所的监测、流行病学和最终结果（SEER）/医疗保险数据库，我们确定了 2000 年至 2007 年间年龄在 67 岁或以上、经诊断患有 I 期 NSCLC 并接受手术切除的患者。手术方法分为肺叶切除术或段切除术（解剖性）与楔形切除术（非解剖性）。我们使用逻辑回归来确定人口统计学、临床和医院因素与非解剖性切除之间的关系。
样本中有 8986 名患者（平均年龄 75 岁；53%为女性）；12.8%接受了非解剖性切除。非解剖性切除术的使用率显著增加，从 2000 年的 11.0%增加到 2007 年的 15.9%（p=0.008）。在多变量分析中，种族与接受非解剖性切除无关。与非解剖性切除相关的因素包括年龄大于 80 岁（比值比[OR]，1.51；95%置信区间[CI]，1.15-1.98）、T1a 原发性肿瘤状态、慢性阻塞性肺疾病（COPD）（OR，1.81；95%CI，1.55-2.12）和医院进行的肺切除术量（最高与最低医院量，OR，1.58；95%CI，1.23-2.04）。与 2000 年相比，2007 年进行了更多的非解剖性切除术（OR，1.73；95%CI，1.27-2.37）。按肿瘤大小分层后，仅在肿瘤大于 3cm 的患者中，非解剖性切除术使用率的时间趋势仍然显著。
自 2000 年以来，I 期 NSCLC 中非解剖性切除术的应用有所增加，在肿瘤较大的患者中增加最为明显。在调整了临床因素后，种族与手术切除类型之间没有关系。
