Long term survival with thoracoscopic versus open lobectomy: propensity matched comparative analysis using SEER-Medicare database.
Long term survival with thoracoscopic versus open lobectomy: propensity matched comparative analysis using SEER-Medicare database.
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DOI：
10.1136/bmj.g5575
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发表时间：
2014-10-02
期刊：
影响因子：
--
通讯作者：
Sedrakyan A
中科院分区：
文献类型：
--
作者：
Paul S;Isaacs AJ;Treasure T;Altorki NK;Sedrakyan A
目的比较微创肺叶切除术与开胸肺叶切除术的远期生存率。设计倾向匹配分析。设置监测，流行病学和最终结果（SEER）-医疗保险数据库。研究对象2007年至2009年接受肺叶切除术的所有肺癌患者。主要观察指标：微创胸腔镜手术对总生存率、无病生存率和癌症特异性生存率的影响。结果2007 ~ 2009年共收治肺叶切除术患者6008例，其中开胸手术4715例（78%）。整个队列的中位年龄为74岁（四分位距70-78）。整个组的中位随访时间为40个月。在每个治疗类别的1195例患者的匹配分析中，在三年总生存率、无病生存率或癌症特异性生存率方面，两组之间没有发现统计学差异（总生存率：70.6% vs 68.1%，P=0.55;无病生存率：86.2% vs 85.4%，P=0.46;癌症特异性生存率：92% vs 89.5%，P=0.05）。结论倾向匹配分析显示，胸腔镜肺叶切除术与开胸肺叶切除术患者的总体生存率、肿瘤特异性生存率和无瘤生存率相似。胸腔镜技术似乎并不影响肺叶切除术后的这些结果。
Objective To compare long term survival after minimally invasive lobectomy and thoracotomy lobectomy. Design Propensity matched analysis. Setting Surveillance, Epidemiology and End Results (SEER)-Medicare database. Participants All patients with lung cancer from 2007 to 2009 undergoing lobectomy. Main outcome measure Influence of less invasive thoracoscopic surgery on overall survival, disease-free survival, and cancer specific survival. Results From 2007 to 2009, 6008 patients undergoing lobectomy were identified (n=4715 (78%) thoracotomy). The median age of the entire cohort was 74 (interquartile range 70-78) years. The median length of follow-up for entire group was 40 months. In a matched analysis of 1195 patients in each treatment category, no statistical differences in three year overall survival, disease-free survival, or cancer specific survival were found between the groups (overall survival: 70.6% v 68.1%, P=0.55; disease-free survival: 86.2% v 85.4%, P=0.46; cancer specific survival: 92% v 89.5%, P=0.05). Conclusion This propensity matched analysis showed that patients undergoing thoracoscopic lobectomy had similar overall, cancer specific, and disease-free survival compared with patients undergoing thoracotomy lobectomy. Thoracoscopic techniques do not seem to compromise these measures of outcome after lobectomy.
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