临床 T4 期非小细胞肺癌的微创外科治疗：国家趋势和结果。

Minimally invasive surgery for clinical T4 non-small-cell lung cancer: national trends and outcomes.

机构信息

Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.

Division of Thoracic and Foregut Surgery, University of Rochester Medical Center, Rochester, NY, USA.

出版信息

Eur J Cardiothorac Surg. 2024 Mar 1;65(3). doi: 10.1093/ejcts/ezae009.

DOI:10.1093/ejcts/ezae009

PMID:38263602

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11007735/

Abstract

OBJECTIVES

Recent randomized data support the perioperative benefits of minimally invasive surgery (MIS) for non-small-cell lung cancer (NSCLC). Its utility for cT4 tumours remains understudied. We, therefore, sought to analyse national trends and outcomes of minimally invasive resections for cT4 cancers.

METHODS

Using the 2010-2019 National Cancer Database, we identified patients with cT4N0-1 NSCLC. Patients were stratified by surgical approach. Multivariable logistic analysis was used to identify factors associated with use of a minimally invasive approach. Groups were matched using propensity score analysis to evaluate perioperative and survival end points.

RESULTS

The study identified 3715 patients, among whom 64.1% (n = 2381) underwent open resection and 35.9% (n = 1334) minimally invasive resection [robotic-assisted in 31.5% (n = 420); and video-assisted in 68.5% (n = 914)]. Increased MIS use was noted among patients with higher income [≥$40 227, odds ratio (OR) 1.24; 95% confidence interval (CI) 1.01-1.51] and those treated at academic hospitals (OR 1.25; 95% CI 1.07-1.45). Clinically node-positive patients (OR 0.68; 95% CI 0.55-0.83) and those who underwent neoadjuvant therapy (OR 0.78; 95% CI 0.65-0.93) were less likely to have minimally invasive resection. In matched groups, patients undergoing MIS had a shorter median length of stay (5 vs 6 days, P < 0.001) and no significant differences between 30-day readmissions or 30/90-day mortality. MIS did not compromise overall survival (log-rank P = 0.487).

CONCLUSIONS

Nationally, the use of minimally invasive approaches for patients with cT4N0-1M0 NSCLC has increased substantially. In these patients, MIS is safe and does not compromise perioperative outcomes or survival.

摘要

目的

最近的随机数据支持微创外科（MIS）在非小细胞肺癌（NSCLC）中的围手术期获益。其在 cT4 肿瘤中的应用仍研究不足。因此，我们试图分析 cT4 癌症微创切除术的全国趋势和结果。

方法

我们使用 2010-2019 年国家癌症数据库，确定了 cT4N0-1 NSCLC 患者。患者按手术方式分层。多变量逻辑分析用于确定与微创方法使用相关的因素。通过倾向评分分析对各组进行匹配，以评估围手术期和生存终点。

结果

该研究共纳入 3715 例患者，其中 64.1%（n=2381）接受了开放性切除术，35.9%（n=1334）接受了微创切除术[机器人辅助手术 31.5%（n=420）；视频辅助手术 68.5%（n=914）]。较高的收入（≥$40227）和在学术医院治疗的患者中，MIS 的使用有所增加（优势比 [OR] 1.24；95%置信区间 [CI] 1.01-1.51）。临床淋巴结阳性患者（OR 0.68；95%CI 0.55-0.83）和接受新辅助治疗的患者（OR 0.78；95%CI 0.65-0.93）不太可能接受微创切除术。在匹配组中，接受 MIS 的患者的中位住院时间更短（5 天与 6 天，P<0.001），30 天再入院率或 30/90 天死亡率无显著差异。MIS 并未影响总体生存率（对数秩检验 P=0.487）。