National Longitudinal Outcomes Following Surgical Therapy for Lung Cancer

肺癌手术治疗后的全国纵向结果

• 批准号: 8761477
• 负责人: Felix Gabriel Fernandez
• 金额: $ 23.65万
• 依托单位: SOCIETY OF THORACIC SURGEONS
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8761477
• 关键词: National; Longitudinal; Outcomes; Following; Surgical

DESCRIPTION (provided by applicant): Lung cancer is the leading cause of cancer mortality in the US. Early stage lung cancer can be cured with surgery, and more early stage tumors are expected to be detected with screening programs. Minimally invasive approaches (video assisted thoracic surgery, VATS) and limited pulmonary resection (sublobar) techniques can reduce procedural morbidity for lung cancer surgery, allowing more patients to have surgery. However, important questions remain about the completeness of cancer removal with these surgical strategies and, therefore, survival outcomes. This represents a critical barrier to matching lung cancer patients with the optimal surgical treatment. A long term goal of The Society of Thoracic Surgeons (STS) is to improve quality of surgical therapy for lung cancer. The STS General Thoracic Surgery Database (GTSD) captures unique patient-level clinical detail not found in any other cancer database. However, the STS GTSD does not provide longitudinal outcomes data, a limitation that can be overcome by linkage to Centers for Medicare and Medicaid Services (CMS) data. Our objective is to identify predictors of long-term outcomes following lung cancer resection, including the optimal strategies with respect to surgical approach and extent of resection. We hypothesize that: 1) long-term survival following lung cancer surgery varies according to individual patient clinical and treatment variables, 2) VATS approaches and sublobar resections are not associated with inferior long-term survival compared to more invasive approaches (thoracotomy), and standard resections (lobectomy), and [3) VATS approaches and sublobar resections are associated with more favorable economic outcomes than standard thoracotomy and lobectomy.] The rationale of this research is that knowledge of risk-adjusted long-term out- comes will facilitate selection of optimal therapy for patients with lung cancer. Our hypotheses will be tested by pursuing three specific aims: 1) Create a risk model for long-term survival following lung cancer resection. 2) Compare survival based on surgical approach, VATS vs. thoracotomy, and extent of resection, sublobar resection vs. lobectomy, for early stage lung cancer. [3) Compare resource use and costs according to surgical approach and extent of resection for early stage lung cancer.] In Aim 1, established algorithms will link the GTSD with CMS data to create a risk model for long-term survival following lung cancer resection. Under Aim 2, VATS approaches and sublobar resections will be compared to thoracotomy approaches and lobectomies with respect to long-term survival with propensity analyses. [Lastly, under Aim 3, costs and resource use associated with VATS and sublobar resections will be compared with thoracotomy and lobectomy, respectively.] This re- search is innovative because linkage of the GTSD with CMS data will create a longitudinal data source uniquely suited for comparative effectiveness studies in lung cancer surgery. The contribution will be significant, as the most effective surgical strategies wil be determined based on individual patient characteristics. These findings will be disseminated by STS nationally and internationally to drive quality improvement in lung cancer care.

描述（由申请人提供）：肺癌是美国癌症死亡的主要原因。早期肺癌可以通过手术治愈，并且预计通过筛查计划可以发现更多早期肿瘤。微创方法（电视辅助胸外科手术，VATS）和有限肺切除（亚肺叶）技术可以降低肺癌手术的手术发病率，使更多患者能够接受手术。然而，关于这些手术策略切除癌症的完整性以及生存结果仍然存在重要问题。这是为肺癌患者提供最佳手术治疗的关键障碍。胸外科医生协会 (STS) 的长期目标是提高肺癌手术治疗的质量。 STS 普通胸外科数据库 (GTSD) 捕获了任何其他癌症数据库中未发现的独特的患者级别临床详细信息。然而，STS GTSD 不提供纵向结果数据，这一限制可以通过与医疗保险和医疗补助服务中心 (CMS) 数据的链接来克服。我们的目标是确定肺癌切除术后长期结果的预测因素，包括手术方法和切除范围的最佳策略。我们假设：1) 肺癌手术后的长期生存率根据个体患者的临床和治疗变量而有所不同，2) 与更具侵入性的方法（开胸术）和标准切除术（肺叶切除术）相比，VATS 方法和亚肺叶切除术与较差的长期生存率无关，并且 [3) VATS 方法和亚肺叶切除术与标准开胸术和标准切除术相比具有更有利的经济结果相关。 ] 这项研究的基本原理是，了解风险调整后的长期结果将有助于为肺癌患者选择最佳治疗方法。我们的假设将通过追求三个具体目标来检验：1）创建肺癌切除后长期生存的风险模型。 2) 比较早期肺癌的手术方法、VATS 与开胸手术以及切除范围、亚肺叶切除与肺叶切除术的生存率。 [3) 根据早期肺癌的手术方法和切除范围来比较资源使用和成本。] 在目标 1 中，已建立的算法将 GTSD 与 CMS 数据联系起来，以创建肺癌切除后长期生存的风险模型。在目标 2 下，将通过倾向分析将 VATS 方法和亚肺叶切除术与开胸术方法和肺叶切除术进行长期生存比较。 [最后，在目标 3 下，与 VATS 和亚肺叶切除术相关的成本和资源使用将分别与开胸手术和肺叶切除术进行比较。]这项研究具有创新性，因为 GTSD 与 CMS 数据的联系将创建一个特别适合肺癌手术比较有效性研究的纵向数据源。 这一贡献将是巨大的，因为最有效的手术策略将根据患者的个体特征来确定。 STS 将在全国和国际范围内传播这些研究结果，以推动肺癌护理质量的提高。