Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas (UTHealth) School of Public Health, Houston, Texas.
J Surg Oncol. 2020 Sep;122(3):495-505. doi: 10.1002/jso.25966. Epub 2020 Apr 30.
The improvement in the management of lung cancer have the potential to improve survival in patients undergoing resection for early-stage (stage I and II) non-small cell lung cancer (NSCLC), but few studies have evaluated time trends and identified predictors of overall survival (OS).
We identified surgically resected early-stage NSCLC between 1998 and 2016. The 3-year OS (1998-2014) and 5-year OS (1998-2012) rates were calculated for each year. Joinpoint regression was used to calculate annual percentage changes (APC) and to test time trends in OS. Multivariable Cox regression was used to identify predictors of OS.
There was a significant upward trend in the 3-year (1998, 56%; 2014, 83%; APC = 1.8) and 5-year (1998, 47%; 2012, 76%; APC = 3.1) OS. Older age; male sex; history of diabetes, coronary artery disease, and chronic obstructive pulmonary disease; high ASA score; smoking pack-years; high-grade tumor; pneumonectomy; thoracotomy; neoadjuvant therapy; nodal disease; and positive tumor margin were predictors of poor OS.
The upward time trend in OS suggests that improved staging, patient selection, and management have conferred a survival benefit in early-stage NSCLC patients. The prediction model of OS could be used to refine selection criteria for resection and improve survival outcomes.
肺癌管理水平的提高有可能改善接受早期（I 期和 II 期）非小细胞肺癌（NSCLC）切除术的患者的生存情况，但很少有研究评估时间趋势并确定总生存（OS）的预测因素。
我们确定了 1998 年至 2016 年期间接受手术切除的早期 NSCLC。计算了每年的 3 年 OS（1998-2014 年）和 5 年 OS（1998-2012 年）率。采用 Joinpoint 回归计算 OS 的年度百分比变化（APC）并检验时间趋势。采用多变量 Cox 回归确定 OS 的预测因素。
3 年 OS（1998 年，56%；2014 年，83%；APC=1.8）和 5 年 OS（1998 年，47%；2012 年，76%；APC=3.1）均呈显著上升趋势。年龄较大；男性；患有糖尿病、冠心病和慢性阻塞性肺疾病史；ASA 评分较高；吸烟包年数；高级别肿瘤；肺切除术；剖胸术；新辅助治疗；淋巴结疾病；以及阳性肿瘤切缘是 OS 不良的预测因素。
OS 的上升时间趋势表明，改进的分期、患者选择和管理为早期 NSCLC 患者带来了生存获益。OS 预测模型可用于完善切除术的选择标准并改善生存结果。
