Video-assisted thoracic surgery versus open thoracotomy for non-small-cell lung cancer: a propensity score analysis based on a multi-institutional registry
Video-assisted thoracic surgery versus open thoracotomy for non-small-cell lung cancer: a propensity score analysis based on a multi-institutional registry
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DOI：
10.1093/ejcts/ezt406
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发表时间：
2013-11-01
影响因子：
3.4
通讯作者：
He, Jianxing
中科院分区：
文献类型：
--
作者：
Cao, Christopher;Zhu, Zhi-Hua;He, Jianxing
接受电视胸腔镜手术（VATS）或传统开放性肺叶切除术的非小细胞肺癌（NSCLC）患者的长期生存率和肿瘤学结局比较仍不确定。我们进行了一项多机构倾向匹配研究，对这些结果的潜在差异进行分层。我们建立了一项多机构登记研究，纳入了中华人民共和国8家机构2001年至2008年接受肺叶切除术的4312例NSCLC患者。年龄、性别、组织学类型和肿瘤分期进入非简约多变量logistic回归模型，以评估长期生存结局。将从逻辑方程得出的预测概率用作每个个体的倾向评分。基于相似的倾向评分，我们将1700例接受VATS肺叶切除术的患者中的1458例与2612例接受开放肺叶切除术的患者中的1458例进行匹配，并比较他们的长期生存结局，2916例匹配患者的平均年龄为59岁（标准差= 11）。在倾向匹配后，VATS和开放性肺叶切除术患者在重要的预后变量方面相似。多因素分析显示，年龄< 60岁（P < 0.001）、女性（P = 0.013）和病理分期（P < 0.001）是影响生存率的独立因素。VATS与开放性肺叶切除术患者的长期生存率相似（P = 0.07），目前的倾向评分分析表明，接受标准化VATS肺叶切除术的NSCLC患者与接受开放性肺叶切除术的患者相比，长期生存率相似。
Comparative long-term survival and oncological outcomes for patients with non-small-cell lung cancer (NSCLC) who undergo video-assisted thoracic surgery (VATS) or conventional open lobectomy remain uncertain. We conducted a multi-institutional propensity-matched study to stratify potential differences in these outcomes.We established a multi-institutional registry for 4312 patients with NSCLC who underwent lobectomy between 2001 and 2008 from eight institutions in the People's Republic of China. Age, gender, histological type and tumour staging were entered into a non-parsimonious multivariable logistic regression model to assess long-term survival outcomes. The predicted probability derived from the logistic equation was used as the propensity score for each individual. Based on similar propensity scores, we matched 1458 of the 1700 patients who underwent VATS lobectomy with 1458 of the 2612 patients who underwent open lobectomy and compared their long-term survival outcomes.The mean age of the 2916 matched patients was 59 (standard deviation = 11) years. After propensity-matching, VATS and open lobectomy patients were similar in regards to important prognostic variables. Three prognostic factors were independently associated with improved survival in the multivariate analysis: age < 60 (P < 0.001), female gender (P = 0.013) and pathological staging (P < 0.001). Patients who underwent VATS vs open lobectomy had similar long-term survival (P = 0.07).The current propensity score analysis suggests that well-matched patients with NSCLC who underwent standardized VATS lobectomy had similar long-term survival outcomes when compared with those who underwent open lobectomy.