Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA.
Harvard Medical School, Massachusetts General Hospital, Boston, MA.
Clin Lung Cancer. 2022 Nov;23(7):600-607. doi: 10.1016/j.cllc.2022.08.008. Epub 2022 Aug 15.
Segmental resection continues to gain favor in the treatment of early-stage non-small cell lung cancer, but there is limited data on outcomes as related to facility volume. The purpose of this study is to better define the relationship between segmentectomy outcomes, survival, and facility volume.
A retrospective cohort analysis was completed using the National Cancer Database. Patients with stage I disease undergoing segmentectomy 2004 to 2015 were included. Facility volume was determined per year; facilities performing higher than the median number of segmental resections were deemed high-volume and retained that classification for the remainder of the study. Propensity-score matching was used to compare 5-year survival and outcomes.
Six hundred eighty-one centers performing 2481 segmentectomies were included. High-volume centers had higher utilization of minimally invasive approaches and lower conversion rates. There was no difference in readmission or 30-day mortality, but 90-day mortality differed between groups (1.2% vs. 2.6%, P = .03). High-volume centers were more likely to sample lymph nodes (88.5% vs. 80.7%, P < .01), and patients were less likely to have positives margins (1.3% vs. 2.7%, P = .03). Patients were no more likely to be upstaged based on facility volume (4.6% vs. 3.3%, P = .21). Overall, 5-year survival was better for patients treated at high-volume centers in the full cohort (69.5% vs. 66.4%, P = .014) but in propensity score-matched analysis this survival difference became non-significant (68.0% vs. 67.9% (P = .172).
Segmentectomy performed at high-volume centers is associated with more frequent use of minimally invasive approach, more frequent negative margins, and improved 90-day survival.
在治疗早期非小细胞肺癌时，节段切除术继续受到青睐，但与机构数量相关的结果数据有限。本研究的目的是更好地定义节段切除术结果、生存和机构数量之间的关系。
使用国家癌症数据库进行回顾性队列分析。纳入 2004 年至 2015 年期间接受 I 期疾病节段切除术的患者。每年确定机构数量；高容量机构施行的节段切除术高于中位数的，被认为是高容量机构，并在研究的其余部分保留该分类。采用倾向评分匹配比较 5 年生存率和结果。
共纳入 681 个施行 2481 例节段切除术的中心。高容量中心更倾向于采用微创方法，且转化率较低。再入院率或 30 天死亡率无差异，但两组间 90 天死亡率不同（1.2%比 2.6%，P =.03）。高容量中心更有可能采样淋巴结（88.5%比 80.7%，P <.01），患者阳性切缘的可能性较低（1.3%比 2.7%，P =.03）。基于机构数量，患者不太可能被升级分期（4.6%比 3.3%，P =.21）。总体而言，高容量中心治疗的患者在全队列中 5 年生存率更高（69.5%比 66.4%，P =.014），但在倾向评分匹配分析中，这种生存差异变得无统计学意义（68.0%比 67.9%（P =.172））。
在高容量中心施行的节段切除术与更频繁地采用微创方法、更频繁地获得阴性切缘以及改善 90 天生存率相关。
