Cancer Epidemiology Group, Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.
Department of Thoracic Surgery, St James's University Hospital, Leeds, UK.
Colorectal Dis. 2021 Jun;23(6):1306-1316. doi: 10.1111/codi.15506. Epub 2021 Jan 24.
Evidence on patterns of use of pulmonary metastasectomy in colorectal cancer patients is limited. This population-based study aims to investigate the use of pulmonary metastasectomy in the colorectal cancer population across the English National Health Service (NHS) and quantify the extent of any variations in practice and outcome.
All adults who underwent a major resection for colorectal cancer in an NHS hospital between 2005 and 2013 were identified in the COloRECTal cancer data Repository (CORECT-R). All inpatient episodes corresponding to pulmonary metastasectomy, occurring within 3 years of the initial colorectal resection, were identified. Multi-level logistic regression was used to determine patient and organizational factors associated with the use of pulmonary metastasectomy for colorectal cancer, and Kaplan-Meier and Cox models were used to assess survival following pulmonary metastasectomy.
In all, 173 354 individuals had a major colorectal resection over the study period, with 3434 (2.0%) undergoing pulmonary resection within 3 years. The frequency of pulmonary metastasectomy increased from 1.2% of patients undergoing major colorectal resection in 2005 to 2.3% in 2013. Significant variation was observed across hospital providers in the risk-adjusted rates of pulmonary metastasectomy (0.0%-6.8% of patients). Overall 5-year survival following pulmonary resection was 50.8%, with 30-day and 90-day mortality of 0.6% and 1.2% respectively.
This study shows significant variation in the rates of pulmonary metastasectomy for colorectal cancer across the English NHS.
有关结直肠癌患者肺转移瘤切除术使用模式的证据有限。本基于人群的研究旨在调查英国国家医疗服务体系（NHS）中结直肠癌患者肺转移瘤切除术的使用情况，并量化实践和结果方面的任何差异程度。
在 COloRECTal cancer data Repository（CORECT-R）中确定了 2005 年至 2013 年期间在 NHS 医院接受结直肠癌主要切除术的所有成年人，并确定了初始结直肠切除术后 3 年内发生的所有肺转移瘤切除术的住院病例。使用多水平逻辑回归确定与结直肠癌肺转移瘤切除术使用相关的患者和组织因素，并使用 Kaplan-Meier 和 Cox 模型评估肺转移瘤切除术后的生存情况。
在整个研究期间，共有 173354 人接受了主要的结直肠切除术，其中 3434 人（2.0%）在 3 年内进行了肺切除术。肺转移瘤切除术的频率从 2005 年接受主要结直肠切除术的患者中 1.2%增加到 2013 年的 2.3%。在医院提供者之间，肺转移瘤切除术的风险调整率存在显著差异（患者的 0.0%-6.8%）。肺切除术后的总体 5 年生存率为 50.8%，30 天和 90 天死亡率分别为 0.6%和 1.2%。
本研究表明，英国 NHS 中结直肠癌肺转移瘤切除术的比率存在显著差异。
