Type of resection and prognosis in lung cancer. Experience of a multicentre study.
Type of resection and prognosis in lung cancer. Experience of a multicentre study.
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肺癌的切除类型和预后。
DOI：
10.1016/j.ejcts.2005.06.026
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发表时间：
2005
影响因子：
3.4
通讯作者：
A. C. Armengod
中科院分区：
文献类型：
--
作者：
R. Rami;Miquel Mateu;J. Freixinet;M. de la Torre;A. Torres;Y. Pun;A. C. Armengod
目标：方法：1993年10月至1997年9月，对2994例经开胸手术治疗的支气管肺癌患者进行前瞻性研究。在招募之前，GCCB-S定义了两种类型的非切除手术（诊断性和探查性开胸术）和三种类型的切除术（完全-CR-：游离切除边缘，纵隔淋巴结夹层，无囊外淋巴结受累，无最远切除淋巴结受累;相对不完全-RIR-：游离切除边缘、无纵隔淋巴结夹层、未切除的淋巴结、累及最远的已切除淋巴结、胸腔积液阳性且无胸膜植入物;以及不完全-IR-：切除边缘阳性、囊外淋巴结受累、未切除的阳性淋巴结、胸腔积液阳性伴胸膜植入物）。对于生存分析，排除了小细胞癌、诱导治疗、术后死亡、未分类手术或失访的患者。结果：1047例（97%）患者由于接受了比纵隔淋巴结清扫更小的淋巴结评估而被定义为RIR。5年生存率和95%置信区间为：诊断性开胸术11%（0 - 30%），探查性开胸术5%（1 - 9%），IR 20%（14 - 26%），RIR 43%（39 - 47%）和CR 45%（41 - 49%）。CR与RIR之间差异无统计学意义（P = 0.18）。结论：CR与RIR不能区分预后差异，应合并为完全切除。
Objective: Analysis of prognosis of the different types of resections for lung cancer defined by the Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery (GCCB-S).Methods: From October 1993 to September 1997, 2994 patients with bronchogenic carcinoma who underwent thoracotomy were prospectively recruited by the GCCB-S. Prior to recruitment, the GCCB-S had defined two types of non-resectional operations (diagnostic and exploratory thoracotomies) and three types of resections (complete-CR-: free resection margins, mediastinal nodal dissection, no extracapsular nodal involvement, no involvement of most distant removed nodes; relatively incomplete-RIR-: free resection margins, no mediastinal nodal dissection, unremoved nodes, involvement of most distant removed nodes, positive pleural effusion with no pleural implants; and incomplete-IR-: positive resection margins, extracapsular nodal involvement, unremoved positive nodes, positive pleural effusion with pleural implants). For survival analyses, patients with small cell carcinoma, induction therapy, postoperative mortality, unclassified operation, or lost to follow-up were excluded. The total number of evaluable patients was 2543.Results: In 1047 (97%) patients, RIR was defined because they had undergone a lesser nodal evaluation than mediastinal nodal dissection. Five-year survival and 95% confidence interval were: diagnostic thoracotomy 11% (0–30%), exploratory thoracotomy 5% (1–9%), IR 20% (14–26%), RIR 43% (39–47%), and CR 45% (41–49%). Differences between IR and CR or RIR were statistically significant (P≪0.0001), but those between CR and RIR were not (P=0.18).Conclusions: CR and RIR should be combined in a single category as complete resection, because they do not discriminate prognostic differences.