Üçvet Ahmet, Gürsoy Soner, Yazgan Serkan
Department of Thoracic Surgery, University of Health Sciences, Dr. Suat Seren Chest Diseases and Surgery Training and Research Center, İzmir, Turkey.
Turk Thorac J. 2020 Jan;21(1):8-13. doi: 10.5152/TurkThoracJ.2019.180124. Epub 2020 Jan 1.
Nonsmall cell lung cancer (NSCLC) is a multifactorial disease, and differences in the characteristics of surgical patients may develop over the years. This study aimed to evaluate the patients who underwent curative surgical resection for NSCLC in the past 20 years at our center and analyze the changes in the treatment strategies based on demographics, surgical strategies, and histopathology.
In this retrospective single-center cohort study, 1995 patients who had undergone lobectomy, bilobectomy, or pneumonectomy for primary NSCLC from January 1997 to January 2017 were analyzed. Patients were divided into two groups: Group I included patients operated in the first 10 years and Group II included patients operated in the last 10 years.
Overall, 77% of patients were operated in the last 10 years (458 vs. 1537 patients). Sleeve lobectomies performed in Group II reduced the rate of pneumonectomy from 37% to 20% (p<0.001). The operation rates for adenocarcinomas increased significantly during the study period, increasing from 31.4% to 36.2% (p=0.049). The 30- and 90-day postoperative mortality rates were 4.6% and 8.5% in Group I and 4.1% and 5.7% in Group II, respectively (p=0.69 and p=0.037, respectively). When the groups were compared, the median and 5-year survival rates were 44.1 months (95% confidence interval [CI], 35.6-52.6) and 42.9% in Group I and 73.6 months (95% CI, 63.3-83.9) and 53.9% in Group II, respectively (p<0.001).
This study demonstrates an improvement in long-term outcomes following lung cancer surgery with an increasing rate of surgical procedures in the last 10 years. There was an increase in the proportion of females affected and the rate of adenocarcinoma. However, the pneumonectomy and postoperative N2 disease rates have decreased with advancing preoperative evaluation techniques and parenchyma-saving surgical methods. Postoperative mortality has decreased, and the survival rate has increased.
非小细胞肺癌（NSCLC）是一种多因素疾病，多年来手术患者的特征可能会有所不同。本研究旨在评估本中心过去20年接受NSCLC根治性手术切除的患者，并根据人口统计学、手术策略和组织病理学分析治疗策略的变化。
在这项回顾性单中心队列研究中，分析了1997年1月至2017年1月因原发性NSCLC接受肺叶切除术、双肺叶切除术或全肺切除术的1995例患者。患者分为两组：第一组包括前10年手术的患者，第二组包括后10年手术的患者。
总体而言，77%的患者是在过去10年接受手术的（458例对1537例）。第二组进行的袖状肺叶切除术使全肺切除术的比例从37%降至20%（p<0.001）。在研究期间，腺癌的手术率显著增加，从31.4%增至36.2%（p=0.049）。第一组术后30天和90天死亡率分别为4.6%和8.5%，第二组分别为4.1%和5.7%（p分别为0.69和0.037）。两组比较时，第一组的中位生存期和5年生存率分别为44.1个月（95%置信区间[CI]，35.6 - 52.6）和42.9%，第二组分别为73.6个月（95%CI，63.3 - 83.9）和53.9%（p<0.001）。
本研究表明，随着过去10年手术率的增加，肺癌手术后的长期预后有所改善。女性患者比例和腺癌发生率有所增加。然而，随着术前评估技术的进步和实质保留手术方法的应用，全肺切除术和术后N2疾病发生率有所下降。术后死亡率降低，生存率提高。
