Mortality Assessment in Lung Cancer Resection

描述(由申请人提供)：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，需要估计患者的疾病严重程度、年龄和合并疾病对死亡风险的综合影响。该应用程序的目标是调查肺癌切除后的死亡率评估。具体目标1将开发和验证一种有效的和临床上有用的方法来估计肺癌切除后患者的特定生存时间。需要一个临床上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。具体目标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。大多数关于体积-结果关系的研究都使用了任意的阈值，而不是确定一个特定的阈值。这一值对于确定实施基于数量的政策对医疗服务的获取和提供的影响至关重要。具体目标1将使用来自胸科外科学会数据库的详细临床数据来解决。COX比例风险回归将作为患者术前特征的函数来估计生存概率。由此产生的综合模型将被用作临床实用的决策支持工具的基础，用于估计患者的特定生存时间。特定目标2使用全国住院患者样本来确定接受肺癌切除的患者。分段多项式函数(样条回归)将被用来确定肺癌切除后显著增加死亡风险的肺癌切除体积的特定阈值。该申请将详细的职业发展计划与研究申请结合在一起。在科佐尔博士的顾问委员会的指导下，他将得到机构的支持。科佐尔博士将发展成为卫生服务研究领域的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、并发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。随着早期肺癌数量的增加，确定哪些患者从肺癌手术治疗中受益的能力最大是至关重要的。

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.