Minimally Invasive Lobectomy Is Associated With Lower Noncancer-specific Mortality in Elderly Patients: A Propensity Score Matched Competing Risks Analysis.
Minimally Invasive Lobectomy Is Associated With Lower Noncancer-specific Mortality in Elderly Patients: A Propensity Score Matched Competing Risks Analysis.
复制标题
DOI：
10.1097/sla.0000000000002772
复制
发表时间：
2019-12
影响因子：
9
通讯作者：
Adusumilli PS
中科院分区：
文献类型：
--
作者：
Hristov B;Eguchi T;Bains S;Dycoco J;Tan KS;Isbell JM;Park BJ;Jones DR;Adusumilli PS
目的比较老年非小细胞肺癌(NSCLC)患者微创肺叶切除术与开胸手术后的肿瘤和非肿瘤特异性死亡率。三分之二的非小细胞肺癌患者是65岁的≥。随着年龄的增长，非癌症死亡等竞争性事件的风险也会增加。纳入老年患者(≥，65岁)，他们在2002年至2013年期间接受了I-III期非小细胞肺癌根治性意向性肺叶切除术，但没有进行诱导治疗(n=1303)。其中，607例患者接受了微创手术，696例患者接受了开胸手术。采用倾向性-分数匹配的方法确定临床特征(如手术年限、合并症和肺功能)相似的开胸手术患者和管理信息系统患者。采用竞争风险法分析手术入路与肺癌特异性和非肿瘤特异性累积死亡发生率(CID)之间的关系。在接受开胸手术的患者(n=338)与开胸患者(n=338)的倾向评分匹配后，与开胸手术相比，开胸手术患者的住院时间更短(p<；0.001)，非癌症特异性1年死亡率更低(p=0.027)，非癌症特异性CID更低(p=0.014)；肺癌特异性CID在两种手术方法之间没有差异。在多变量分析中，开胸手术是非癌症特异性死亡的重要危险因素(亚危险比2.45，95%可信区间1.18-5.06，p=0.016)，与年龄、性别和肺部一氧化碳扩散能力无关。在倾向评分匹配的队列中，多变量分析表明，在老年非小细胞肺癌患者中，与开胸手术相比，采用管理信息系统行肺叶切除术的非癌症特异性死亡率较低。我们使用竞争风险分析比较了老年非小细胞肺癌患者(65岁的≥)行微创肺叶切除术和开胸手术后的癌症和非癌症特异性死亡率。在倾向评分匹配的队列中，与开胸手术相比，微创手术与非癌症特异性死亡率相关。
To investigate cancer- and noncancer-specific mortality following lobectomy by minimally invasive surgery (MIS) versus open thoracotomy in elderly patients with non-small cell lung cancer (NSCLC). Two-thirds of patients with NSCLC are ≥65 years of age. As age increases, the risk of competing events, such as noncancer death, also increases. Elderly patients (≥65 years of age) who have undergone curative-intent lobectomy for stage I-III NSCLC without induction therapy (2002–2013) were included (n=1 303). Of those, 607 patients had undergone MIS and 696 had undergone thoracotomy. Propensity-score matching was performed to identify pairs of thoracotomy and MIS patients with comparable clinical characteristics (e.g., year of surgery, comorbidities, and pulmonary function). Association between surgical approach (MIS vs. thoracotomy) and lung cancer-specific and noncancer-specific cumulative incidence of death (CID) was analyzed using competing risks approach. Following propensity score matching of patients who had undergone thoracotomy (n=338) versus MIS (n=338), MIS was associated with shorter length of stay (p <0.001), lower noncancer-specific 1-year mortality (p=0.027), and lower noncancer-specific CID (p=0.014) compared with thoracotomy; there was no difference in lung cancer-specific CID between surgical approaches. On multivariable analysis, thoracotomy was a significant risk factor for noncancer-specific death (subhazard ratio 2.45, 95% CI 1.18–5.06, p=0.016) independent of age, sex, and diffusion capacity of the lungs for carbon monoxide. In a propensity score-matched cohort, multivariable analysis has indicated that lobectomy performed by MIS is associated with lower incidence of noncancer-specific mortality compared with lobectomy performed by open thoracotomy in elderly patients with NSCLC. We investigated cancer- and noncancer-specific mortality following lobectomy by minimally invasive surgery versus open thoracotomy in elderly patients (≥65 years of age) with non-small cell lung cancer using competing risks analysis. In a propensity score-matched cohort, minimally invasive surgery was associated with lower incidence of noncancer-specific mortality compared with thoracotomy.