Martin Jeremiah T, Durbin Eric B, Chen Li, Gal Tamas, Mahan Angela, Ferraris Victor, Zwischenberger Joseph
Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky.
Department of Biostatistics, University of Kentucky, Lexington, Kentucky.
Ann Thorac Surg. 2016 Jan;101(1):238-44; discussion 44-5. doi: 10.1016/j.athoracsur.2015.05.136. Epub 2015 Sep 28.
Recent reports indicate that thoracoscopic lobectomy for lung cancer may be associated with lower rates of surgical upstaging. We queried a statewide cancer registry for differences in upstaging rates and survival by surgical approach.
The Kentucky Cancer Registry (KCR) collects data, including centralized pathology reporting, on cancer patients treated statewide. We performed a retrospective review from 2010 to 2012 to examine clinical and pathologic stage. We assessed rates of upstaging and whether the surgical approach, thoracotomy (THOR) versus minimally invasive techniques (video-assisted thoracic surgery; VATS), had an impact on final pathologic stage and survival.
The KCR database from 2010 to 2012 contained information on 2830 lung cancer cases, 1964 having THOR procedure and 500 having VATS resections. Preoperatively, 36.4% of THOR were clinically stage 1a versus 47.4% VATS (p = 0.0002). Of these, final pathologic stage remained stage 1a in 30.5% of THOR procedures and 38.0% of VATS (p = 0.0002). The overall nodal upstaging rate for THOR was 9.9% and 4.8% for VATS (p = 0.002). Decreased nodal upstaging was found with VATS, independent of tumor size and extent of resection (odds ratio 0.6, 95% confidence interval [CI]: 0.387 to 0.985, p = 0.04). However, improved survival was found with VATS compared with THOR (hazard ratio 0.733, 95% CI: 0.592 to 0.907, p = 0.0042).
Consistent with other reports, we report a lower upstaging rate with VATS. Nevertheless, there is a survival advantage in VATS patients. Although selection bias may play a role in these observed differences, the improved quality of life measures associated with VATS may explain survival improvement despite lower surgical upstaging.
近期报告表明，肺癌的胸腔镜肺叶切除术可能与手术分期升级率较低有关。我们查询了全州癌症登记处，以了解手术方式在分期升级率和生存率方面的差异。
肯塔基癌症登记处（KCR）收集了全州范围内癌症患者的数据，包括集中病理报告。我们对2010年至2012年的数据进行了回顾性审查，以检查临床和病理分期。我们评估了分期升级率，以及手术方式（开胸手术[THOR]与微创技术[电视辅助胸腔手术；VATS]）是否对最终病理分期和生存率有影响。
2010年至2012年的KCR数据库包含2830例肺癌病例的信息，其中1964例行开胸手术，500例行VATS切除术。术前，36.4%的开胸手术患者临床分期为1a期，而VATS手术患者为47.4%（p = 0.0002）。其中，30.5%的开胸手术患者最终病理分期仍为1a期，VATS手术患者为38.0%（p = 0.0002）。开胸手术的总体淋巴结分期升级率为9.9%，VATS为4.8%（p = 0.002）。发现VATS可降低淋巴结分期升级，与肿瘤大小和切除范围无关（比值比0.6，95%置信区间[CI]：0.387至0.985，p = 0.04）。然而，与开胸手术相比，VATS患者的生存率有所提高（风险比0.733，95%CI：0.592至0.907，p = 0.0042）。
与其他报告一致，我们报告VATS的分期升级率较低。尽管如此，VATS患者有生存优势。虽然选择偏倚可能在这些观察到的差异中起作用，但与VATS相关的生活质量改善措施可能解释了尽管手术分期升级较低但生存率仍有所提高的原因。
