Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Suwon, Korea.
Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
Thorac Cancer. 2022 Apr;13(8):1211-1219. doi: 10.1111/1759-7714.14391. Epub 2022 Mar 20.
Textbook outcome (TO) has been introduced as a novel composite measure for lung cancer surgery. We investigated TO after lobectomy for early-stage non-small cell lung cancer (NSCLC) in a Korean tertiary hospital and its prognostic implications for overall survival and recurrence.
Between January 2012 and December 2017, 418 consecutive patients who underwent lobectomy for clinical stages I and II NSCLC were identified and retrospectively reviewed. TO was defined as complete resection (negative resection margins and sufficient lymph node dissection), no 30-day or in-hospital mortality, no reintervention within 30 days, no readmission to the intensive care unit, no prolonged hospital stay (<14 days), no hospital readmission within 30 days, and no major complications. Propensity score matching analysis was performed to investigate the association between TO, medical costs, and long-term outcomes.
Of 418 patients, 277 (66.3%) achieved TO. The most common events leading to TO failure were prolonged air leakage (n = 54, 12.9%) and prolonged hospital stay (n = 53, 12.7%). Male sex (odds ratio [OR] = 2.148, p = 0.036) and low diffusing capacity for carbon monoxide (OR = 0.986, p = 0.047) were significant risk factors for failed TO in multivariate analysis. In matched cohorts, achieving TO was associated with lower medical costs and better overall survival but not cancer recurrence.
TO is associated with low medical cost and favorable overall survival; thus, surgical teams and hospitals should make efforts to improve the quality of care and achieve TO.
教科书结局（Textbook outcome，TO）已被引入作为肺癌手术的一种新的综合衡量指标。我们在一家韩国的三级医院调查了 TO 在早期非小细胞肺癌（non-small cell lung cancer，NSCLC）肺叶切除术后的情况，及其对总生存和复发的预后意义。
2012 年 1 月至 2017 年 12 月，我们回顾性分析了 418 例在我院接受 I 期和 II 期 NSCLC 肺叶切除术的连续患者。TO 定义为完全切除（阴性切缘和足够的淋巴结清扫）、30 天或住院内无死亡、30 天内无再次干预、无入住重症监护病房、无住院时间延长（<14 天）、30 天内无再次住院、无重大并发症。进行倾向评分匹配分析，以研究 TO、医疗费用与长期结果之间的关系。
在 418 例患者中，277 例（66.3%）达到了 TO。导致 TO 失败的最常见事件是长时间漏气（n=54，12.9%）和住院时间延长（n=53，12.7%）。多因素分析显示，男性（比值比[OR] 2.148，p=0.036）和低一氧化碳弥散量（OR 0.986，p=0.047）是 TO 失败的显著危险因素。在匹配队列中，达到 TO 与较低的医疗费用和更好的总生存相关，但与癌症复发无关。
TO 与较低的医疗费用和良好的总生存相关；因此，外科团队和医院应努力改善护理质量并实现 TO。
