Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. Electronic address: https://www.twitter.com/huroqu90.
Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
Surgery. 2024 Sep;176(3):918-926. doi: 10.1016/j.surg.2024.05.039. Epub 2024 Jul 3.
The circumstances under which pneumonectomy should be performed are controversial. This study aims to investigate national trends in pneumonectomy use to determine which patients, in what geographic areas, and under what clinical circumstances pneumonectomy is performed in the United States.
We queried the National Cancer Database and included all patients undergoing anatomic surgical resection for non-small cell lung cancer (2015-2020). The association between demographic and clinical factors and the use of pneumonectomy were investigated.
Who: A total of 128,421 patients were identified, of whom 738 (0.6%) underwent pneumonectomy. Those patients were younger (median 65 vs 68 years, P < .001), more often male (59.9% vs 44.9%, P < .001), more likely to be below median income level (44.2% vs 38.6%, P = .002), and more likely to have lower education indicators (53% vs 48.6%, P = .02) than those who underwent other anatomic resections. Notably, there was a decreasing trend in pneumonectomy use during the study period (0.9% down to 0.4%, P < .001). Where: Patients undergoing pneumonectomy were less likely to live in metropolitan areas (77.9% vs 81.7%, P = .008) and to live closer (<12 miles) to their treating facility (45% vs 49%, P = .02). Regional geographic differences also were identified (P < .001). Why: Patients who underwent pneumonectomy were more likely to have received neoadjuvant therapy (20.6% vs 5.3%, P < .001), to be clinically N (+) (39.3% vs 12.3%, P < .001), and to have more advanced tumors (cT3-4: 46.3% vs 11.3%, P < .001).
Although primarily driven by advanced oncologic features, socioeconomic and geographic factors also were associated independently with the use of pneumonectomy. Standardizing pneumonectomy indications nationwide is crucial to prevent widening outcome gaps for patients with lung cancer.
肺切除术的实施情况存在争议。本研究旨在调查美国肺切除术使用的国家趋势，以确定在美国哪些患者、在哪些地理区域和在哪些临床情况下进行肺切除术。
我们查询了国家癌症数据库，纳入了所有接受非小细胞肺癌解剖性手术切除的患者（2015-2020 年）。调查了人口统计学和临床因素与肺切除术使用之间的关联。
谁：共确定了 128421 名患者，其中 738 名（0.6%）接受了肺切除术。这些患者年龄较小（中位数 65 岁比 68 岁，P<.001），男性更多（59.9%比 44.9%，P<.001），收入水平低于中位数的可能性更高（44.2%比 38.6%，P=.002），教育水平指标更低（53%比 48.6%，P=.02）。与接受其他解剖性切除术的患者相比，有下降趋势（0.9%下降到 0.4%，P<.001）。哪里：接受肺切除术的患者更不可能居住在大都市区（77.9%比 81.7%，P=.008），也更不可能居住在距离治疗机构较近（<12 英里）的地方（45%比 49%，P=.02）。还发现了区域地理差异（P<.001）。为什么：接受肺切除术的患者更有可能接受新辅助治疗（20.6%比 5.3%，P<.001），临床 N（+）（39.3%比 12.3%，P<.001），肿瘤更晚期（cT3-4：46.3%比 11.3%，P<.001）。
尽管主要由先进的肿瘤学特征驱动，但社会经济和地理因素也与肺切除术的使用独立相关。在全国范围内标准化肺切除术的适应证对于防止肺癌患者的预后差距扩大至关重要。
