National cooperative group trials of "high-risk" patients with lung cancer: are they truly "high-risk"?
National cooperative group trials of "high-risk" patients with lung cancer: are they truly "high-risk"?
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DOI：
10.1016/j.athoracsur.2013.12.028
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发表时间：
2014-05
影响因子：
4.6
通讯作者：
Meyers, Bryan F.
中科院分区：
文献类型：
--
作者：
Puri, Varun;Crabtree, Traves D.;Bell, Jennifer M.;Kreisel, Daniel;Krupnick, Alexander S.;Broderick, Stephen;Patterson, G. Alexander;Meyers, Bryan F.
美国外科肿瘤学会（ACOSOG）试验z4032和z4033前瞻性地将肺癌患者描述为手术的“高风险”，这些结果经常出现在文献中。我们假设许多符合这些试验客观入选标准的患者（“高风险”）与“正常风险”患者具有相似的围手术期结局。我们回顾了一个前瞻性的机构数据库，并根据ACOSOG主要标准将临床I期肺癌切除术患者分为“高危”和“正常风险”。从2000年到2010年，1066例患者因临床I期肺癌接受了手术。其中，194例（18%）符合ACOSOG主要风险标准（术前FEV 1或DLCO ≤50%预测值）。“高风险”患者年龄较大（66.4 vs. 64.6岁，p=0.02），但在性别、高血压、糖尿病和冠状动脉疾病（CAD）患病率方面与对照组相似。“高危”患者比正常患者更不可能接受肺叶切除术（117/194，60% vs. 665/872，76%，p<0.001）。“高风险”患者和对照患者的发病率相似（任何并发症：55/194，28% vs. 230/872，26%，p=0.59），30天死亡率相似（2/194，1% vs. 14/872，2%，p=0.75）。在回归分析中，年龄（HR 1.04，95% CI 1.02-1.06）和CAD（HR 1.58，95% CI 1.05-2.40）与接受肺叶切除术的患者并发症风险升高相关，而女性（HR 0.63，95% CI 0.44-0.91）具有保护作用。ACOSOG“高危”状态与围手术期发病率无关。根据ACOSOG试验入组标准，尽管有相当比例的“高危”患者接受了肺叶切除术，但被定性为“高危”和“正常风险”的肺癌患者之间的早期结局没有重要差异。
The American College of Surgery Oncology Group (ACOSOG) trials z4032 and z4033 prospectively characterized lung cancer patients as “high-risk” for surgery and these results have appeared frequently in literature. We hypothesized that many patients meeting objective enrollment criteria for these trials (“high-risk”) have similar perioperative outcomes as “normal-risk” patients. We reviewed a prospective institutional database, and classified patients undergoing resection for clinical stage I lung cancer as “high-risk” and “normal-risk” by ACOSOG major criteria. From 2000 – 2010, 1066 patients underwent surgery for clinical stage I lung cancer. Of these, 194 (18%) met ACOSOG major criteria for risk (preoperative FEV1 or DLCO ≤50% predicted). “High-risk” patients were older (66.4 vs. 64.6 years, p=0.02) but similar to controls in gender, prevalence of hypertension, diabetes, and coronary artery disease (CAD). “High-risk” patients were less likely than normal patients to undergo a lobectomy (117/194, 60% vs. 665/872, 76%, p<0.001). “High-risk” and control patients experienced similar morbidity (any complication: 55/194, 28% vs. 230/872, 26%, p=0.59), and 30-day mortality (2/194, 1% vs. 14/872, 2%, p=0.75). In a regression analysis, age (HR 1.04, 95% CI 1.02–1.06), and CAD (HR 1.58, 95% CI 1.05–2.40) were associated with an elevated risk of complications in those undergoing lobectomy, while female gender (HR 0.63, 95% CI 0.44–0.91) was protective. ACOSOG “high-risk” status was not associated with perioperative morbidity. There are no important differences in early outcomes between lung cancer patients characterized as “high-risk” and “normal-risk” by ACOSOG trial enrollment criteria, despite a significant proportion of “high-risk” patients undergoing lobectomy.
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DOI：
10.1053/j.semtcvs.2010.04.002
发表时间：
2010-03-01
影响因子：
2.5
作者：
Brunelli, Alessandro
通讯作者：
Brunelli, Alessandro
影响因子：
4.6
作者：
Licker, MJ;Widikker, I;Rocco, G
通讯作者：
Rocco, G
DOI：
10.1016/j.jtcvs.2012.06.003
发表时间：
2012-09
期刊：
The Journal of thoracic and cardiovascular surgery
影响因子：
--
作者：
Fernando HC;Timmerman R
通讯作者：
Timmerman R
影响因子：
3.4
作者：
Ferguson, Mark K.;Siddique, Juned;Karrison, Theodore
通讯作者：
Karrison, Theodore
影响因子：
4.6
作者：
Wright, Cameron D.;Gaissert, Henning A.;Allen, Mark S.
通讯作者：
Allen, Mark S.