Husain Zain A, Kim Anthony W, Yu James B, Decker Roy H, Corso Christopher D
Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT.
Department of Thoracic Surgery, Yale School of Medicine, New Haven, CT.
Clin Lung Cancer. 2015 Nov;16(6):e183-7. doi: 10.1016/j.cllc.2015.04.007. Epub 2015 Apr 24.
The National Cancer Data Base was examined for predictors of 30-day mortality (30-DM) in early stage none small-cell lung cancer patients undergoing resection. The rate of 30-DM was 2.2%. Age, community treatment center, male sex, and Charlson-Deyo comorbidity score were predictive of higher mortality. Extent of resection was predictive of higher 30-DM in patients aged ‡ 75 years.
Studies examining morbidity after lobectomy for early stage non-small-cell lung cancer (NSCLC) demonstrate a > 50% incidence of complications in patients aged ≥ 65 years. Factors that affect 30-day mortality (30-DM), however, are less well defined.
The National Cancer Data Base was used to identify patients age ≥ 19 years with stage I NSCLC between 2003 and 2011. Data from patients undergoing lobectomy or sublobar resection was abstracted. Univariable and multivariable logistic regression analyses were performed for predictors of 30-DM.
A total of 71,175 patients met inclusion criteria. Of these, 81% underwent lobectomy and 19% underwent sublobar resection. The median age was 68 years. Charlson-Deyo (CD) comorbidity score was 0 in 49% of patients and 1 or higher in 51%. The rate of 30-DM was 2.2%. On multivariable analysis, younger age, CD score of 0, female sex, tumor size ≤ 3 cm, and treatment at an academic center was associated with lower 30-DM (P < .001). A model of 30-DM incorporating age, comorbidity, and extent of surgery was created. In patients aged < 75 years without comorbidities, 30-DM was 1.3%. However, in elderly patients (≥ 75 years old) with CD score of 2, this rate quadrupled to 5.8% (P < .01). Lobectomy patients in this group had higher 30-DM compared to sublobar resection patients (6.6% vs. 3.9% respectively, P < .01).
The 30-DM rate following sublobar or lobar resection in this national sample was low. Extent of resection appears to influence 30-DM in the elderly. Elderly patients with a CD score of 2 undergoing lobectomy represent a high-risk group for 30-DM.
对国家癌症数据库进行了检查，以确定接受手术的早期非小细胞肺癌患者30天死亡率（30-DM）的预测因素。30-DM发生率为2.2%。年龄、社区治疗中心、男性性别和Charlson-Deyo合并症评分可预测较高的死亡率。在年龄≥75岁的患者中，手术切除范围可预测较高的30-DM。
对早期非小细胞肺癌（NSCLC）肺叶切除术后发病率的研究表明，年龄≥65岁的患者并发症发生率>50%。然而，影响30天死亡率（30-DM）的因素尚不太明确。
使用国家癌症数据库识别2003年至2011年间年龄≥19岁的I期NSCLC患者。提取接受肺叶切除术或肺段切除术患者的数据。对30-DM的预测因素进行单变量和多变量逻辑回归分析。
共有71175例患者符合纳入标准。其中，81%接受了肺叶切除术，19%接受了肺段切除术。中位年龄为68岁。49%的患者Charlson-Deyo（CD）合并症评分为0，51%的患者评分为1或更高。30-DM发生率为2.2%。多变量分析显示，年龄较小、CD评分为0、女性性别、肿瘤大小≤3 cm以及在学术中心接受治疗与较低的30-DM相关（P<.001）。创建了一个包含年龄、合并症和手术范围的30-DM模型。在年龄<75岁且无合并症的患者中，30-DM为1.3%。然而，在CD评分为2的老年患者（≥75岁）中，这一比例增至5.8%，为之前的四倍（P<.01）。该组肺叶切除术患者的30-DM高于肺段切除术患者（分别为6.6%和3.9%，P<.01）。
在这个全国性样本中，肺段或肺叶切除术后的30-DM发生率较低。手术切除范围似乎会影响老年人的30-DM。CD评分为2的老年患者接受肺叶切除术是30-DM的高危人群。
