Rosen Joshua E, Hancock Jacquelyn G, Kim Anthony W, Detterbeck Frank C, Boffa Daniel J
Department of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut.
Department of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut.
Ann Thorac Surg. 2014 Dec;98(6):1953-60. doi: 10.1016/j.athoracsur.2014.07.007. Epub 2014 Oct 18.
Surgical resection represents the standard of care for locoregionally confined non-small cell lung cancer (NSCLC); however, surgical complications may compromise the overall outcome. Adverse events after lung cancer surgery have been studied extensively, yet available databases have significant limitations (with respect to size, provider, patient age, and so forth). The National Cancer Database (NCDB) is the largest cancer registry in the world, capturing 67% of newly diagnosed NSCLC in the United States. We studied surgically managed NSCLC patients in the NCDB to more accurately assess factors that influence perioperative outcomes.
Patients diagnosed with NSCLC from 2004 to 2009 in the NCDB who were managed with surgical resection were included (n = 119,146). Primary endpoints included death within 30 days of surgery and extended length of stay (more than 14 days).
Overall 30-day mortality rate was 3.4% and varied by procedure: lobectomy/bilobectomy (2.6%), wedge resection (4.2%), extended lobectomy/bilobectomy (4%), and pneumonectomy (8.5%). By multivariable analysis, increasing age, male sex, increasing comorbidities, and decreased facility volume were associated with higher 30-day mortality. Of patients who underwent lobectomy, 9.1% had an extended length of stay. On multivariable analysis, increasing age, male sex, increasing comorbidities, decreasing facility volume, and right-sided tumors were associated with increased incidence of extended length of stay.
Adverse events after the surgical treatment of NSCLC in the NCDB occur with a similar frequency and are predicted by similar patient, procedural, and facility variables as have been identified by more restricted data resources. The NCDB appears to be a valuable resource to study NSCLC in the United States.
手术切除是局部局限期非小细胞肺癌（NSCLC）的标准治疗方法；然而，手术并发症可能会影响总体治疗效果。肺癌手术后的不良事件已得到广泛研究，但现有数据库存在显著局限性（在规模、医疗机构、患者年龄等方面）。美国国立癌症数据库（NCDB）是世界上最大的癌症登记处，收录了美国67%新诊断的NSCLC病例。我们研究了NCDB中接受手术治疗的NSCLC患者，以更准确地评估影响围手术期结局的因素。
纳入2004年至2009年在NCDB中诊断为NSCLC并接受手术切除治疗的患者（n = 119,146）。主要终点包括术后30天内死亡和延长住院时间（超过14天）。
总体30天死亡率为3.4%，因手术方式而异：肺叶切除术/双肺叶切除术（2.6%）、楔形切除术（4.2%）、扩大肺叶切除术/双肺叶切除术（4%）和全肺切除术（8.5%）。多变量分析显示，年龄增加、男性、合并症增加和医疗机构手术量减少与30天死亡率较高相关。接受肺叶切除术的患者中，9.1%出现延长住院时间。多变量分析显示，年龄增加、男性、合并症增加、医疗机构手术量减少和右侧肿瘤与延长住院时间的发生率增加相关。
NCDB中NSCLC手术治疗后的不良事件发生率相似，且与更有限的数据资源所确定的患者、手术和医疗机构变量相似，可据此进行预测。NCDB似乎是研究美国NSCLC的宝贵资源。
