Heart Center, Turku University Hospital, Turku, Finland.
Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland.
Eur J Cardiothorac Surg. 2018 Jul 1;54(1):127-133. doi: 10.1093/ejcts/ezx486.
The aim of this study was to investigate the current trends and results of lung cancer surgery in Finland at the population level.
Three compulsory national registries provided the data on surgical treatment of lung cancer during 2004 and 2014. Outcomes of interest were all-cause mortality, population level surgical rates and frequencies of resections. The data were divided into 2 eras to analyse changes in treatment strategies and baseline characteristics: 2004-2009 and 2010-2014.
A total of 3621 patients underwent lung resections for cancer during the study period. The mean age of the patients was 65.8 years. During the study period, the patients were older and Charlson comorbidity index score of the patients increased (P < 0.001 for both). Simultaneously, the rate of surgery (from 12.8% to 14.4%, P = 0.001) and the rate of video-assisted thoracoscopic surgery increased (from 7.3% to 31.9%, P < 0.001). The rate of pneumonectomy decreased from 12.7% to 7.5% (P < 0.001). Mortality was 2.3% at 30 days and 4.3% at 90 days without significant differences between eras. Overall survival was 85% at 1 year and 50.2% at 5 years. Long-term survival improved significantly during the study from 53% to 60.1% at 4 years (P < 0.001).
This nationwide population-based study demonstrates an improvement in long-term outcome after lung cancer surgery despite an increasing age and comorbidity burden concomitantly with an increasing rate of surgery. This suggests that video-assisted thoracoscopic surgery can be offered to more patients with more comorbidities while still improving lung cancer survival.
本研究旨在调查芬兰人群中肺癌手术的当前趋势和结果。
三个强制性国家登记处提供了 2004 年至 2014 年肺癌手术治疗的数据。研究目的是全因死亡率、人群水平手术率和切除频率。将数据分为两个时期来分析治疗策略和基线特征的变化：2004-2009 年和 2010-2014 年。
研究期间共对 3621 例肺癌患者进行了肺切除术。患者的平均年龄为 65.8 岁。在此期间，患者年龄较大，Charlson 合并症指数评分增加（两者均 P<0.001）。同时，手术率（从 12.8%增加到 14.4%，P=0.001）和电视辅助胸腔镜手术率（从 7.3%增加到 31.9%，P<0.001）增加。肺切除术的比例从 12.7%下降到 7.5%（P<0.001）。30 天和 90 天的死亡率分别为 2.3%和 4.3%，两个时期无明显差异。1 年生存率为 85%，5 年生存率为 50.2%。研究期间，长期生存率显著提高，4 年时从 53%提高到 60.1%（P<0.001）。
这项全国性的基于人群的研究表明，尽管年龄和合并症负担增加，手术率增加，但肺癌手术后的长期结果得到了改善。这表明，尽管合并症更多，仍可以为更多患者提供电视辅助胸腔镜手术，同时提高肺癌生存率。
