Variations in surgeon treatment recommendations for lobectomy in early-stage non-small-cell lung cancer by patient age and comorbidity.
Variations in surgeon treatment recommendations for lobectomy in early-stage non-small-cell lung cancer by patient age and comorbidity.
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DOI：
10.1245/s10434-010-0946-y
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发表时间：
2010-06
影响因子：
3.7
通讯作者：
Keating NL
中科院分区：
文献类型：
--
作者：
Rogers SO Jr;Gray SW;Landrum MB;Klabunde CN;Kahn KL;Fletcher RH;Clauser S;Tisnado D;Doucette W;Keating NL
先前的研究表明，老年患者不太可能接受早期非小细胞肺癌（NSCLC）切除术。我们对外科医生进行了调查，以了解他们对肺叶切除术的建议如何受到年龄，吸烟相关肺部疾病的存在和严重程度，或外科医生及其实践的影响。我们调查了照顾NSCLC患者的外科医生是否会建议对年龄（55岁与80岁）和共病（无、中度、重度慢性阻塞性肺疾病[COPD]）不同的假设早期NSCLC患者进行肺叶切除术。有序逻辑回归被用来确定病人，外科医生和手术建议的实践特征的重要性。外科医生建议几乎所有55岁无合并症（调整比例98.6%）、55岁中度COPD（调整比例97.8%）或80岁无合并症（调整比例98.1%）的患者进行肺叶切除术。80岁以上中度COPD患者推荐行肺叶切除术的比例较低（调整后比例为82.3%），而不考虑年龄因素，重度COPD患者推荐行肺叶切除术的比例更低（55岁患者调整后比例为18.7%，80岁患者调整后比例为6.1%）（P < 0.002）。招募患者参加临床试验的外科医生（P = 0.03）比其他人更有可能推荐肺叶切除术，但没有其他外科医生特征预测建议。老年患者中较低的肺叶切除率似乎不能用外科医生对其他健康患者的年龄相关偏见来解释。
Prior research suggests that older patients are less likely to undergo resection of early-stage non-small-cell lung carcinomas (NSCLCs). We surveyed surgeons to understand how their recommendations for lobectomy were influenced by age, the presence and severity of smoking-related lung disease, or by characteristics of the surgeons and their practices. We surveyed surgeons caring for NSCLC patients regarding whether they would recommend lobectomy for hypothetical patients with early-stage NSCLC who varied by age (55 vs. 80 years) and comorbid illness (none, moderate, severe chronic obstructive pulmonary disease [COPD]). Ordinal logistic regression was used to identify the importance of patient, surgeon, and practice characteristics on surgery recommendations. Surgeons recommended lobectomy for nearly all patients who were 55 years old with no comorbidity (adjusted proportion 98.6%), 55 years old with moderate COPD (adjusted proportion 97.8%), or 80 years old with no comorbidity (adjusted proportion 98.1%). Fewer recommended lobectomy for 80-year-old patients with moderate COPD (adjusted proportion 82.3%), and far fewer recommended lobectomy for severe COPD, irrespective of age (adjusted rate 18.7% for the 55-year-old patient and 6.1% for the 80-year-old patient) (P < 0.002). Surgeons who enroll patients onto clinical trials (P = 0.03) were more likely than others to recommend lobectomy, but no other surgeon characteristic predicted recommendations. Lower rates of lobectomy among older patients do not seem to be explained by age-related biases among surgeons for otherwise healthy patients.
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影响因子：
4.6
作者：
Demmy, TL;Curtis, JJ
通讯作者：
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