Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York 10065, USA.
Ann Thorac Surg. 2013 Sep;96(3):951-60; discussion 960-1. doi: 10.1016/j.athoracsur.2013.04.104. Epub 2013 Jul 16.
Video-assisted thoracic surgery (VATS) lobectomy for non-small cell lung cancer (NSCLC) is increasingly popular. However, the oncologic soundness of VATS for patients with NSCLC as measured by long-term survival has not been proven. The objective here is to determine the overall survival (OS) and disease-free survival (DFS) in two well-matched groups of patients with NSCLC resected by VATS or thoracotomy.
We conducted a retrospective review of a prospective database to identify patients who had a lobectomy for NSCLC. A propensity score-matched analysis was done with variables of age, sex, smoking history, Charlson comorbidity index, forced expiratory volume in 1 second, lung diffusing capacity for carbon monoxide, histology, and clinical T and N status. Medical records were reviewed and survival was analyzed.
After matching, there were 208 patients in each group. Patient and tumor characteristics were similar. The VATS group had a shorter length of stay. More nodes (14.3 versus 11.3; p=0.001) and more nodal stations (3.8 versus 3.1; p<0.001) were removed by thoracotomy. No differences were seen in OS and DFS. Median follow-up was 36 months. More than 90% of patients had clinical stage I disease, with 3- and 5-year OS of 87.4% and 76.5%, respectively, for VATS, and 81.6% and 77.5%, respectively, for thoracotomy (p=0.672). Both the incidence and distribution of recurrence were similar. Multivariate Cox regression analyses of OS and DFS confirmed the noninferiority of VATS.
For patients with clinical stage I NSCLC, VATS lobectomy offered similar OS and DFS compared with thoracotomy. Thoracotomy offers a more thorough lymph node evaluation, and may be appropriate for patients with more advanced clinical disease.
电视辅助胸腔镜手术（VATS）肺叶切除术治疗非小细胞肺癌（NSCLC）越来越受欢迎。然而，VATS 治疗 NSCLC 患者的长期生存的肿瘤学效果尚未得到证实。本研究旨在通过比较 VATS 与开胸手术切除 NSCLC 患者的总生存（OS）和无病生存（DFS）来确定 VATS 的总体生存（OS）和无病生存（DFS）。
我们对一个前瞻性数据库进行了回顾性研究，以确定接受 NSCLC 肺叶切除术的患者。通过年龄、性别、吸烟史、Charlson 合并症指数、1 秒用力呼气量、肺一氧化碳弥散量、组织学以及临床 T 和 N 分期等变量进行倾向评分匹配分析。回顾病历并进行生存分析。
匹配后，每组各有 208 例患者。患者和肿瘤特征相似。VATS 组的住院时间较短。开胸手术组切除的淋巴结（14.3 比 11.3；p=0.001）和淋巴结站数（3.8 比 3.1；p<0.001）更多。OS 和 DFS 无差异。中位随访时间为 36 个月。超过 90%的患者患有临床 I 期疾病，VATS 组的 3 年和 5 年 OS 分别为 87.4%和 76.5%，开胸手术组分别为 81.6%和 77.5%（p=0.672）。复发的发生率和分布相似。OS 和 DFS 的多变量 Cox 回归分析证实了 VATS 的非劣效性。
对于临床 I 期 NSCLC 患者，VATS 肺叶切除术与开胸手术相比，具有相似的 OS 和 DFS。开胸手术提供了更彻底的淋巴结评估，可能适合更晚期临床疾病的患者。
