Pneumonectomy for lung cancer: Contemporary national early morbidity and mortality outcomes
Pneumonectomy for lung cancer: Contemporary national early morbidity and mortality outcomes
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DOI：
10.1016/j.jtcvs.2014.09.063
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发表时间：
2015-01-01
影响因子：
6
通讯作者：
Loundou, Anderson
中科院分区：
文献类型：
--
作者：
Thomas, Pascal A.;Berbis, Julie;Loundou, Anderson
目的：研究目的是确定当代肺癌全肺切除术相关的早期预后，并使用具有全国代表性的普通胸外科数据库（上皮）确定其预测因素。方法：在剔除不一致的文献后，选取2003 - 2013年间行选择性全肺切除术的原发性肺癌患者4498例。对死亡率和主要不良事件的变量进行Logistic回归分析。然后，对接受或未接受新辅助治疗的患者基线特征的不平衡进行倾向评分分析。结果：手术死亡率为7.8%。手术、心血管、肺部和感染并发症发生率分别为14.9%、14.1%、11.5%和2.7%。新辅助治疗的表现没有预测到这些并发症。倾向分数手术死亡率分析、调整,确定年龄大于65岁(优势比[或],2.1;95%可信区间(CI), 1.5 - -2.9; P <措施),体重不足身体质量指数类别(优势比,2.2;95%置信区间,1.2 - -4.0;P = .009),美国麻醉医师学会分3或更高(优势比,2.310;95%置信区间,1.615 - -3.304;P <措施),正确的一侧的过程(优势比,1.8;95%置信区间,1.1 - -2.4;P = .011),性能扩展肺切除术(优势比,1.5;95%置信区间,1.1 - -2.1;P = 0.018)和未行系统性淋巴结切除术（OR, 2.9; 95% CI, 1.1-7.8; P = 0.027）作为风险预测因素。诱导治疗（OR, 0.63; 95% CI, 0.5-0.9; P = 0.005）和超重体重指数类别（OR, 0.60; 95% CI, 0.4-0.9; P = 0.033）是保护因素。结论：确定了肿瘤全肺切除术后主要不良早期结局的几个危险因素。超重患者和接受诱导治疗的患者调整后的死亡率风险反而较低。
Objective: The study objective was to determine contemporary early outcomes associated with pneumonectomy for lung cancer and to identify their predictors using a nationally representative general thoracic surgery database (EPITHOR).Methods: After discarding inconsistent files, a group of 4498 patients who underwent elective pneumonectomy for primary lung cancer between 2003 and 2013 was selected. Logistic regression analysis was performed on variables for mortality and major adverse events. Then, a propensity score analysis was adjusted for imbalances in baseline characteristics between patients with or without neoadjuvant treatment.Results: Operative mortality was 7.8%. Surgical, cardiovascular, pulmonary, and infectious complications rates were 14.9%, 14.1%, 11.5%, and 2.7%, respectively. None of these complications were predicted by the performance of a neoadjuvant therapy. Operative mortality analysis, adjusted for the propensity scores, identified age greater than 65 years (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.5-2.9; P < .001), underweight body mass index category (OR, 2.2; 95% CI, 1.2-4.0; P = .009), American Society of Anesthesiologists score of 3 or greater (OR, 2.310; 95% CI, 1.615-3.304; P < .001), right laterality of the procedure (OR, 1.8; 95% CI, 1.1-2.4; P = .011), performance of an extended pneumonectomy (OR, 1.5; 95% CI, 1.1-2.1; P = .018), and absence of systematic lymphadenectomy (OR, 2.9; 95% CI, 1.1-7.8; P = .027) as risk predictors. Induction therapy (OR, 0.63; 95% CI, 0.5-0.9; P = .005) and overweight body mass index category (OR, 0.60; 95% CI, 0.4-0.9; P = .033) were protective factors.Conclusions: Several risk factors for major adverse early outcomes after pneumonectomy for cancer were identified. Overweight patients and those who received induction therapy had paradoxically lower adjusted risks of mortality.