英国肺癌的最佳切除率：我们应该达到多高？

Optimal resection rate for lung cancer in the UK: how high should we go?

机构信息

Department of Thoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

Department of Thoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.

出版信息

BMJ Open Respir Res. 2021 Jul;8(1). doi: 10.1136/bmjresp-2020-000771.

DOI:10.1136/bmjresp-2020-000771

PMID:34326151

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8323385/

Abstract

BACKGROUND

The optimal resection rate for institutions managing early-stage primary lung cancer is not known. Whether the prognosis of patients who do not proceed to operation is determined by their comorbidities for which they were deemed at prohibitively high-operative risk, or disease progression, is uncertain. We investigated the outcomes of patients with early-stage lung cancer who were considered for surgical management.

METHODS

We reviewed the outcomes of consecutive patients who were considered for resection of early-stage primary lung cancer at Oxford University Hospitals National Health Service Foundation Trust between 2012 and 2017.

RESULTS

Between 29 November 2012 and 31 March 2017, 467 consecutive patients underwent resection with curative intent for primary lung cancer (operative group), while 81 patients were deemed resectable but either inoperable or did not wish to proceed to operation (non-operative group). Reason for not proceeding to resection was cardiovascular in 16 patients (19.8%), respiratory in 21 (25.9%), cardiorespiratory in 11 (13.6%), performance status in 8 (9.9%) and patient choice in 25 (30.9%) patients. Sixty-six patients (81.5%) received an alternative radical treatment. Median follow-up was 169 weeks (IQR 119-246 weeks) in the operative group and 118 weeks (IQR 74-167 weeks) in the non-operative group. Median survival of patients with early-stage lung cancer who did not proceed to operation was 2.5 years; median survival of patients undergoing lung cancer resection was undefined (p<0.0001). Lung cancer was documented as directly or indirectly leading to or contributing to death in 40 patients (76.9%). In 11 patients, the cause of death was due to comorbidities (21.2%).

CONCLUSIONS

Patients turned down for operation in a high-resection rate UK unit have limited survival due to lung cancer progression. We conclude that 'optimal' resection rates may not have been reached in the UK even in high-resection rate centres.

摘要

背景

目前尚不清楚管理早期原发性肺癌的机构的最佳切除率。未行手术的患者的预后是由使他们手术风险过高的合并症决定，还是由疾病进展决定，这并不确定。我们研究了接受手术治疗的早期肺癌患者的结局。

方法

我们回顾了 2012 年至 2017 年期间在牛津大学医院国民保健服务基金会信托机构接受早期原发性肺癌切除术的连续患者的结局。

结果

2012 年 11 月 29 日至 2017 年 3 月 31 日，467 例连续患者接受了以治愈为目的的原发性肺癌切除术（手术组），而 81 例被认为可切除但无法手术或不愿手术（非手术组）。未行切除术的原因是心血管 16 例（19.8%）、呼吸 21 例（25.9%）、心肺 11 例（13.6%）、身体状态 8 例（9.9%）和患者选择 25 例（30.9%）。66 例（81.5%）患者接受了替代根治性治疗。手术组的中位随访时间为 169 周（IQR 119-246 周），非手术组为 118 周（IQR 74-167 周）。未行手术的早期肺癌患者的中位生存时间为 2.5 年；行肺癌切除术的患者的中位生存时间未定义（p<0.0001）。40 例（76.9%）患者的肺癌被记录为直接或间接导致或促成死亡。11 例患者的死因是合并症（21.2%）。