. Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
. Escola de Enfermagem, Universidade de Sao Paulo, Sao Paulo, SP, BR.
J Bras Pneumol. 2020 Dec 16;47(1):e20190426. doi: 10.36416/1806-3756/e20190426. eCollection 2020.
To evaluate the evolution of clinical and epidemiological data, as well as data related to diagnosis, staging, treatment, and survival, among patients undergoing curative surgery for lung cancer at a tertiary referral center in the city of São Paulo, Brazil.
This was a retrospective study of cases in the International Association for the Study of Lung Cancer database. We selected only cases of patients undergoing curative surgery between January of 2011 and April of 2018. We determined overall and disease-free survival at 36 months and compared the data between two periods (2011-2014 and 2015-2018).
Comparing the two periods (N = 437 cases), we observed trends toward increases in the number of female patients, as well as in the proportions of former smokers (44.09% vs. 53.59%), of patients diagnosed with adenocarcinoma (52.21% vs. 59.72%), and of patients diagnosed at an earlier pathological stage, together with a decrease in 30-day mortality (4.05% vs. 2.39%). There were significant increases in the proportions of cases diagnosed at an earlier clinical stage (p = 0.002) or incidentally (p = 0.003). Although lobectomy was the main surgical technique employed, there was a proportional increase in segmentectomies (2.67% vs. 7.11%; p = 0.026). Overall and disease-free survival rates were 79.4% (95% CI: 74.0-83.9%) and 75.1% (95% CI: 69.1-80.1%), respectively. The difference in overall survival between the periods lost statistical significance when adjusted for pathological stage, the only factor that affected survival (log-rank: p = 0.038 to p = 0.079).
The clinical and epidemiological evolution presented in this study corroborates global trends. The decrease in 30-day mortality was probably due to better patient selection and improved surgical techniques.
评估在巴西圣保罗市一家三级转诊中心接受肺癌根治性手术的患者的临床和流行病学数据以及与诊断、分期、治疗和生存相关的数据的演变情况。
这是一项在国际肺癌研究协会数据库中进行的回顾性研究。我们仅选择 2011 年 1 月至 2018 年 4 月期间接受根治性手术的患者的病例。我们确定了 36 个月的总生存率和无病生存率，并比较了两个时期（2011-2014 年和 2015-2018 年）的数据。
比较两个时期（N=437 例），我们观察到女性患者数量增加的趋势，以及曾经吸烟者（44.09%对 53.59%）、腺癌诊断比例（52.21%对 59.72%）和更早病理分期诊断的患者比例增加，同时 30 天死亡率降低（4.05%对 2.39%）。更早临床分期（p=0.002）或偶然诊断（p=0.003）的病例比例显著增加。虽然肺叶切除术是主要的手术技术，但节段切除术的比例有所增加（2.67%对 7.11%；p=0.026）。总生存率和无病生存率分别为 79.4%（95%CI：74.0-83.9%）和 75.1%（95%CI：69.1-80.1%）。在调整病理分期后，两个时期的总生存率差异失去统计学意义，唯一影响生存的因素（对数秩检验：p=0.038 至 p=0.079）。
本研究中呈现的临床和流行病学演变与全球趋势相符。30 天死亡率的降低可能归因于更好的患者选择和改进的手术技术。
