原发性肺癌合并心脏病患者的管理和术后结局：系统评价和荟萃分析。
Management and postoperative outcome in primary lung cancer and heart disease co-morbidity: a systematic review and meta-analysis.
机构信息
1 Technological Educational Institute of Athens, Faculty of Health and Caring Professions, Agiou Spyridonos, 12243, Egaleo, Athens, Greece ; 2 Department of Physiology, Medical School, Democritus University of Thrace, Dragana 68100, Alexandroupolis, Greece ; 3 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527, Goudi, Athens, Greece ; 4 Department of Occupational Lung Diseases and Tuberculosis, "Sismanogleio" General Hospital, 15126, Maroussi, Athens, Greece.
出版信息
Ann Transl Med. 2016 Jun;4(11):213. doi: 10.21037/atm.2016.06.02.
BACKGROUND
Co-morbidity of primary lung cancer (LC) and heart disease (HD), both requiring surgical therapy, characterizes a high risk group of patients necessitating prompt diagnosis and treatment. The aim of this study is the review of available evidence guiding the management of these patients.
METHODS
Postoperative outcome of patients operated for primary LC (first meta-analysis) and for both primary LC and HD co-morbidity (second meta-analysis), were studied. Parameters examined in both meta-analyses were thirty-day postoperative mortality, postoperative complications, three- and five-year survival probabilities. The last 36 years were reviewed by using the PubMed data base. Thirty-seven studies were qualified for both meta-analyses.
RESULTS
The pooled 30-day mortality percentages (%) were 4.16% [95% confidence interval (CI): 2.68-5.95] (first meta-analysis) and 5.26% (95% CI: 3.47-7.62) (second meta-analysis). Higher percentages of squamous histology and lobectomy, were significantly associated with increased (P=0.001) and decreased (P<0.001) thirty-day postoperative mortality, respectively (first meta-analysis). The pooled percentages for postoperative complications were 34.32% (95% CI: 24.59-44.75) (first meta-analysis) and 45.59% (95% CI: 35.62-55.74) (second meta-analysis). Higher percentages of squamous histology (P=0.001), lobectomy (P=0.002) and p-T1 or p-T2 (P=0.034) were associated with higher proportions of postoperative complications (second meta-analysis). The pooled three- and five- year survival probabilities were 68.25% (95% CI: 45.93-86.86) and 52.03% (95% CI: 34.71-69.11), respectively. Higher mean age (P=0.046) and percentage lobectomy (P=0.009) significantly reduced the five-year survival probability.
CONCLUSIONS
Lobectomy and age were both accompanied by reduced five-year survival rate. Also, combined aorto-coronary bypass grafting (CABG) with lobectomy for squamous pT1 or pT2 LC displayed a higher risk of postoperative complications. Moreover, medical decision between combined or staged surgery is suggested to be individualized based on adequacy of coronary arterial perfusion, age, patient's preoperative performance status (taking into account possible co-morbidities per patient), tumor's staging and extent of lung resection.
背景
原发性肺癌（LC）和心脏病（HD）合并症都需要手术治疗，这使患者成为需要快速诊断和治疗的高危人群。本研究的目的是回顾指导这些患者管理的现有证据。
方法
研究了接受原发性 LC（第一组荟萃分析）和原发性 LC 和 HD 合并症（第二组荟萃分析）手术的患者的术后结果。在这两项荟萃分析中检查的参数是术后 30 天死亡率、术后并发症、3 年和 5 年生存率。通过使用 PubMed 数据库回顾了过去 36 年的数据。有 37 项研究符合这两项荟萃分析的要求。
结果
汇总的 30 天死亡率百分比分别为 4.16%（95%置信区间[CI]：2.68-5.95%）（第一组荟萃分析）和 5.26%（95%CI：3.47-7.62%）（第二组荟萃分析）。较高的鳞状组织学和肺叶切除术百分比与增加（P=0.001）和减少（P<0.001）术后 30 天死亡率显著相关（第一组荟萃分析）。术后并发症的汇总百分比为 34.32%（95%CI：24.59-44.75%）（第一组荟萃分析）和 45.59%（95%CI：35.62-55.74%）（第二组荟萃分析）。较高的鳞状组织学百分比（P=0.001）、肺叶切除术（P=0.002）和 p-T1 或 p-T2（P=0.034）与更高比例的术后并发症相关（第二组荟萃分析）。汇总的 3 年和 5 年生存率分别为 68.25%（95%CI：45.93-86.86%）和 52.03%（95%CI：34.71-69.11%）。较高的平均年龄（P=0.046）和肺叶切除术百分比（P=0.009）显著降低了 5 年生存率。
结论
肺叶切除术和年龄均与 5 年生存率降低有关。此外，对于鳞状 pT1 或 pT2 LC，主动脉冠状动脉旁路移植术（CABG）与肺叶切除术联合使用会增加术后并发症的风险。此外，建议根据冠状动脉灌注充足性、年龄、患者术前表现状态（考虑每位患者可能存在的合并症）、肿瘤分期和肺切除术范围，对联合或分期手术的医学决策进行个体化。
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