Contemporary Results of Surgical Resection of Non-small Cell Lung Cancer After Induction Therapy A Review of 549 Consecutive Cases
Contemporary Results of Surgical Resection of Non-small Cell Lung Cancer After Induction Therapy A Review of 549 Consecutive Cases
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DOI：
10.1097/jto.0b013e318228a0d8
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发表时间：
2011-09-01
影响因子：
20.4
通讯作者：
Kris, Mark G.
中科院分区：
文献类型：
--
作者：
Barnett, Stephen A.;Rusch, Valerie W.;Kris, Mark G.
目的：我们之前报道过非小细胞肺癌诱导治疗和肺切除术后死亡率较高。最近的报告表明这些患者的手术死亡率正在下降。我们分析了当前的结果，以确定手术死亡率和决定手术风险的因素。方法：从我们的前瞻性手术数据库中识别出符合条件的患者。并发症根据美国国家癌症研究所不良事件通用术语标准 3.0 进行分级。单变量和多变量逻辑回归模型评估了术前测试和临床特征与结果的关联。采用留一交叉验证方案计算受试者工作特征曲线和受试者工作特征曲线下面积（AUC）统计数据，以评估各种模型的预测价值。 结果：2000年1月至2006年12月，549例患者在诱导治疗后接受了手术。患者中位年龄为 64 岁（范围：30-86），其中 54% 为女性 (298/549)。所有人都接受了化疗，17% 还接受了放疗。肺叶切除术（388/549，71%）和肺切除术（70/549，13%）是最常见的手术。 250 名患者 (46%) 出现并发症，其中 23% (126/549) 发生 3 级或以上并发症。院内死亡率为 1.8% (10/549)，仅 1 例右肺切除术后死亡 (1/30，3%)。多变量分析表明，预测的术后（PPO）肺功能与术后发病率相关。通过接受者操作特征曲线，PPO乘积（AUC = 0.75，p = 0.001）、PPO扩散能力（AUC = 0.70，p < 0.001）和术前预测的PPO扩散能力百分比（AUC = 0.66，p < 0.001）预测死亡率。结论：我们目前的经验表明，诱导治疗（包括全肺切除术）后非小细胞肺癌的切除与低死亡率相关。死亡率。 PPO 肺功能是手术风险最强的预测因子，应用于选择手术患者。
Objective: We previously reported a high mortality after induction therapy and pneumonectomy for non-small cell lung cancer. Recent reports suggest that operative mortality in these patients is declining. We analyzed our contemporary results to define operative mortality and factors determining surgical risk.Methods: Eligible patients were identified from our prospective surgical database. Complications were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events 3.0. Uni- and multivariate logistic regression models assessed the association of preoperative tests and clinical characteristics with outcome. Receiver operating characteristic curves and area under the receiver operating characteristic curve (AUC) statistics were calculated in a leave-one-out crossvalidation scheme to evaluate the predictive value of various models.Results: From January 2000 to December 2006, 549 patients underwent surgery after induction therapy. Median patient age was 64 years (range: 30-86), and 54% were women (298/549). All received chemotherapy, and 17% also had radiation. Lobectomy (388/549, 71%) and pneumonectomy (70/549, 13%) were the most common procedures. Complications occurred in 250 patients (46%), with grade 3 or higher in 23% (126/549). Inhospital mortality was 1.8% (10/549), with only one death after right pneumonectomy (1/30, 3%). Multivariate analysis showed that predicted postoperative (PPO) pulmonary function was associated with postoperative morbidity. By receiver operating characteristic curves, PPO product (AUC = 0.75, p = 0.001), PPO diffusion capacity (AUC = 0.70, p < 0.001), and preoperative % predicted PPO diffusion capacity (AUC = 0.66, p < 0.001) predicted mortality.Conclusion: Our current experience shows that resection of non-small cell lung cancer after induction therapy, including pneumonectomy, is associated with low mortality. PPO pulmonary function is the strongest predictor of operative risk and should be used to select patients for surgery.