Mortality Assessment in Lung Cancer Resection

肺癌切除术中的死亡率评估

• 批准号: 8066775
• 负责人: Benjamin D Kozower
• 金额: $ 15.03万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8066775
• 关键词: Mortality; Assessment; Lung; Cancer; Resection

DESCRIPTION (provided by applicant): Surgical resection remains the optimal therapy for the management of patients with early stage lung cancer. Determining which patients have the greatest capacity to benefit from surgical therapy requires estimating the combined effects of the patient's severity of disease, age, and co-morbid disease on mortality risk. The goal of this application is to investigate mortality assessment following lung cancer resection. Specific Aim 1 will develop and validate an efficient and clinically useful method to estimate patient specific survival following lung cancer resection. A clinically useful tool is needed to facilitate informed clinical decision making, patient counseling and appropriate resource allocation. Specific Aim 2 will determine the specific threshold value of hospital volume at which mortality risk is substantially Increased following lung cancer resection. Most studies of the volume-outcome relationship have used arbitrary thresholds rather than identifying a specific threshold value. This value is imperative to determine the impact of implementing volume based policies on access and delivery of care. Specific Aim 1 will be addressed using detailed clinical data from the Society of Thoracic Surgeons Database. Cox proportional hazard regression will estimate the probability of survival as a function of patient preoperative characteristics. The resulting comprehensive model will be used as the basis of a clinically practical decision support tool for use in estimating patient specific survival. Specific Aim 2 uses the Nationwide Inpatient Sample to identify patients having lung cancer resection. Piecewise polynomial functions (spline regression) will be used to determine the specific threshold value for the volume of lung cancer resections that substantially increases mortality risk following lung cancer resection. This application combines a detailed career development plan along with the research application. With the guidance from Dr. Kozower's advisory committee and the institutional support he will receive. Dr. Kozower will develop the skills required to evolve into an Independent Investigator In health services research. RELEVANCE (See instructions): Lung cancer is the leading cause of cancer death In the United States. Morbidity and mortality following lung cancer resection are common due to the age and comorbidiy of the patients along with the complexity of the treatment. Determining which patients have the greatest capacity to benefit from surgical treatment of lung cancer is crucial as the number of early stage lung cancers is increasing.

描述（申请人提供）：手术切除仍然是治疗早期肺癌患者的最佳治疗方法。确定哪些患者最有能力从手术治疗中获益，需要估计患者疾病严重程度、年龄和合并症对死亡风险的综合影响。本应用程序的目的是调查肺癌切除术后的死亡率评估。Specific Aim 1将开发和验证一种有效和临床有用的方法来估计肺癌切除术后患者的特异性生存。需要一种临床有用的工具来促进知情的临床决策，患者咨询和适当的资源分配。特异性目标2将确定肺癌切除后死亡风险显著增加的医院容量的特定阈值。大多数关于容量-结果关系的研究都使用了任意阈值，而不是确定一个特定的阈值。这一价值对于确定实施基于数量的政策对获得和提供医疗服务的影响至关重要。具体目标1将使用来自胸外科学会数据库的详细临床数据来解决。Cox比例风险回归将估计生存概率作为患者术前特征的函数。由此产生的综合模型将被用作临床实用决策支持工具的基础，用于估计患者的特定生存率。Specific Aim 2使用全国住院患者样本来识别肺癌切除术患者。分段多项式函数（样条回归）将用于确定肺癌切除量的具体阈值，该阈值会大大增加肺癌切除后的死亡风险。该申请结合了详细的职业发展计划以及研究申请。在科佐尔博士咨询委员会的指导下以及他将得到的机构支持下。Kozower博士将培养成为卫生服务研究领域独立调查员所需的技能。相关性（见说明）：肺癌是美国癌症死亡的主要原因。由于患者的年龄和合并症以及治疗的复杂性，肺癌切除术后的发病率和死亡率是常见的。随着早期肺癌的数量不断增加，确定哪些患者最有能力从肺癌手术治疗中获益是至关重要的。