Conditional Cancer-Specific Versus Cardiovascular-Specific Survival After Lobectomy for Stage I Non-Small Cell Lung Cancer
Conditional Cancer-Specific Versus Cardiovascular-Specific Survival After Lobectomy for Stage I Non-Small Cell Lung Cancer
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DOI：
10.1016/j.athoracsur.2010.04.100
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发表时间：
2010-08-01
影响因子：
4.6
通讯作者：
Maddaus, Michael A.
中科院分区：
文献类型：
--
作者：
Groth, Shawn S.;Rueth, Natasha M.;Maddaus, Michael A.
背景有条件的癌症特异性生存率解释了癌症死亡风险随时间的变化。在随访过程中，可能有一个点，即I期非小细胞肺癌（NSCLC）患者接受肺叶切除术后死于心血管疾病的可能性与死于癌症的可能性一样。利用监测流行病学和最终结果数据库（1988年至2005年），我们确定了50岁及以上因I期NSCLC接受肺叶切除术的患者。我们使用竞争风险的方法来计算条件生存率，并确定是否有一个点，在后续的癌症死亡的风险相当于死于心血管疾病的风险。总共有22，518名患者符合我们的入选标准。癌症死亡的5年条件概率和心血管疾病死亡的5年条件概率的差异随着时间的推移而降低;在整个队列中，如果患者在肺叶切除术后存活至7年，则这些概率相等（p = 0.11）。随着年龄的增长，死于癌症的概率和死于心血管疾病的概率在较早的时间点变得相等。此外，年龄在70~79岁的患者在肺叶切除术后存活7年和年龄在80岁及以上的患者在肺叶切除术后存活5年的5年死于心血管疾病的概率显著高于5年死于癌症的概率。对于I期NSCLC行肺叶切除术的患者，心血管特异性死亡率在随访过程中变得越来越重要，尤其是在老年患者中。(Ann Thorac Surg 2010; 90：375 - 82）（C）2010年，胸外科医师协会
Background. Conditional cancer-specific survival rates account for changes in the risk of death from cancer over time. There may be a point during follow-up when patients who undergo lobectomy for stage I non-small cell lung cancer (NSCLC) are as likely to die of cardiovascular disease as of cancer.Methods. Using the Surveillance Epidemiology and End Results Database (1988 through 2005), we identified patients 50 years old and older who underwent lobectomy for stage I NSCLC. We used competing risks methods to calculate conditional survival rates and to ascertain if there is a point in follow-up where the risk of dying of cancer is equivalent to the risk of dying of cardiovascular disease.Results. In all, 22,518 patients met our inclusion criteria. The difference in the 5-year conditional probability of dying of cancer and the 5-year conditional probability of dying of cardiovascular disease decreased with time; in the whole cohort, these probabilities were equivalent if patients survived to 7 years after lobectomy (p = 0.11). With increasing age, the probability of dying of cancer and the probability of dying of cardiovascular disease became equivalent at earlier time points. Furthermore, the 5-year probability of dying of cardiovascular disease was significantly greater than the 5-year probability of dying of cancer for patients aged 70 to 79 years who survived to 7 years and for patients aged 80 years and older who survived to 5 years after lobectomy.Conclusions. For patients undergoing lobectomy for stage I NSCLC, cardiovascular-specific mortality becomes increasingly important over the course of follow-up, especially among elderly patients. (Ann Thorac Surg 2010;90:375-82) (C) 2010 by The Society of Thoracic Surgeons