Outcomes After Use of a Lymph Node Collection Kit for Lung Cancer Surgery: A Pragmatic, Population-Based, Multi-Institutional, Staggered Implementation Study.
Outcomes After Use of a Lymph Node Collection Kit for Lung Cancer Surgery: A Pragmatic, Population-Based, Multi-Institutional, Staggered Implementation Study.
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DOI：
10.1016/j.jtho.2020.12.025
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发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
Klesges LM
中科院分区：
文献类型：
--
作者：
Osarogiagbon RU;Smeltzer MP;Faris NR;Ray MA;Fehnel C;Ojeabulu P;Akinbobola O;Meadows-Taylor M;McHugh LM;Halal AM;Levy P;Sachdev V;Talton D;Wiggins L;Shu XO;Shyr Y;Robbins ET;Klesges LM
在肺癌的治疗意图切除后，亚理想的病理淋巴结分期盛行。我们在一项前瞻性、基于人群的交错实施研究中评估了淋巴结标本采集试剂盒对肺癌手术结果的影响。从2014年1月1日至2018年8月28日，我们在三个同质机构队列中实施了该试剂盒，涉及来自四个相邻医院转诊区的11家符合条件的医院。我们的主要结果是病理淋巴结分期质量，由以下循证措施定义：检查的淋巴结或淋巴结的数量，未检查淋巴结等低质量标记物的比例，以及包括国家综合癌症网络（NCCN）标准在内的综合质量基准。其他结果包括围手术期并发症、医疗保健利用和总生存率。在1492名参与者中，56%的人使用试剂盒进行了切除，44%的人没有。kit病例的病理淋巴结分期质量明显更高：0.2%的kit病例没有检查淋巴结，而9.8%的非kit病例没有检查淋巴结；3.2%对25.3%没有纵隔淋巴结；75%比26%达到NCCN标准（所有比较p<0.0001）。Kit病例在围手术期并发症或医疗保健利用方面没有差异，除了手术时间明显缩短，肺不张比例较低，输血使用率略高。使用试剂盒切除与较低的死亡风险相关（粗值0.78 [95% CI 0.61-0.99]；校正值0.85[0.71 - 1.02]）。肺癌手术采用淋巴结收集试剂盒可显著改善病理淋巴结分期质量，生存率有提高的趋势，围手术期发病率和死亡率均不高。
Suboptimal pathologic nodal staging prevails after curative-intent resection of lung cancer. We evaluated a lymph node specimen collection kit’s impact on lung cancer surgery outcomes in a prospective, population-based, staggered implementation study. From January 1, 2014 to August 28, 2018, we implemented the kit in three homogeneous institutional cohorts involving 11 eligible hospitals from four contiguous Hospital Referral Regions. Our primary outcome was pathologic nodal staging quality, defined by the following evidence-based measures: the number of lymph nodes or stations examined, proportions with poor-quality markers such as non-examination of lymph nodes, and aggregate quality benchmarks including the National Comprehensive Cancer Network (NCCN) criteria. Additional outcomes included perioperative complications, healthcare utilization, and overall survival. Of 1492 participants, 56% had resection with the kit, 44% without. Pathologic nodal staging quality was significantly higher in the kit cases: 0.2% of kit cases versus 9.8% of non-kit cases had no lymph nodes examined; 3.2% versus 25.3% had no mediastinal lymph nodes; 75% versus 26% attained NCCN criteria (p<0.0001 for all comparisons). Kit cases showed no difference in perioperative complications or healthcare utilization except for significantly shorter duration of surgery, lower proportions with atelectasis, and slightly higher use of blood transfusion. Resection with the kit was associated with a lower hazard of death (crude, 0.78 [95% CI 0.61–0.99]; adjusted 0.85 [0.71 to 1.02]). Lung cancer surgery with a lymph node collection kit significantly improved pathologic nodal staging quality, with a trend towards survival improvement, without excessive perioperative morbidity or mortality.
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检查的淋巴结计数对切除的非小细胞肺癌的精确分期和长期生存的影响：美国 SEER 数据库和中国多机构登记的人群研究
DOI：
10.1200/jco.2016.67.5140
发表时间：
2017-04-10
期刊：
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
影响因子：
--
作者：
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通讯作者：
He J
影响因子：
20.4
作者：
Osarogiagbon, Raymond U.;Faris, Nicholas R.;Smeltzer, Matthew P.
通讯作者：
Smeltzer, Matthew P.
影响因子：
20.4
作者：
Osarogiagbon, Raymond U.;Yu, Xinhua
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Yu, Xinhua
影响因子：
20.4
作者：
Rusch, Valerie W.;Asamura, Hisao;Goldstraw, Peter
通讯作者：
Goldstraw, Peter
淋巴结的数量与病理淋巴结非小细胞肺癌中长期死亡率风险最大相关的淋巴结数量。
影响因子：
4.6
作者：
Osarogiagbon, Raymond U.;Ogbata, Obiageli;Yu, Xinhua
通讯作者：
Yu, Xinhua