Predictors of Mortality After Surgical Management of Lung Cancer in the National Cancer Database
Predictors of Mortality After Surgical Management of Lung Cancer in the National Cancer Database
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DOI：
10.1016/j.athoracsur.2014.07.007
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发表时间：
2014-12-01
影响因子：
4.6
通讯作者：
Boffa, Daniel J.
中科院分区：
文献类型：
--
作者：
Rosen, Joshua E.;Hancock, Jacquelyn G.;Boffa, Daniel J.
背景资料。手术切除是局部局限性非小细胞肺癌(NSCLC)的标准治疗方法；然而，手术并发症可能会影响整体预后。肺癌手术后的不良事件已经得到了广泛的研究，但现有的数据库有很大的局限性(关于大小、提供者、患者年龄等)。国家癌症数据库(NCDB)是世界上最大的癌症登记系统，涵盖了美国67%的新诊断非小细胞肺癌。我们对非疾控中心的手术治疗的非小细胞肺癌患者进行了研究，以更准确地评估影响围手术期结果的因素。纳入2004年至2009年在非疾控中心接受手术切除治疗的非小细胞肺癌患者(n=119,146)。主要终点包括手术后30天内死亡和延长住院时间(超过14天)。总的30天死亡率为3.4%，不同的手术方式不同：肺叶/双叶切除术(2.6%)、楔形切除术(4.2%)、扩大的肺叶/双叶切除术(4%)和肺切除术(8.5%)。通过多变量分析，年龄、男性、合并症的增加和设施容量的减少与较高的30天死亡率相关。在接受肺叶切除术的患者中，9.1%的患者住院时间延长。在多变量分析中，年龄增加、男性、合并症增加、设施体积减小和右侧肿瘤与延长住院时间的发生率增加相关。NCDB的NSCLC手术治疗后的不良事件发生的频率相似，并且由更有限的数据来源确定的相似的患者、程序和设施变量来预测。NCDB似乎是研究美国非小细胞肺癌的宝贵资源。(C)2014年，由胸外科医生学会主办
Background. Surgical resection represents the standard of care for locoregionally confined non-small cell lung cancer (NSCLC); however, surgical complications may compromise the overall outcome. Adverse events after lung cancer surgery have been studied extensively, yet available databases have significant limitations (with respect to size, provider, patient age, and so forth). The National Cancer Database (NCDB) is the largest cancer registry in the world, capturing 67% of newly diagnosed NSCLC in the United States. We studied surgically managed NSCLC patients in the NCDB to more accurately assess factors that influence perioperative outcomes.Methods. Patients diagnosed with NSCLC from 2004 to 2009 in the NCDB who were managed with surgical resection were included (n = 119,146). Primary endpoints included death within 30 days of surgery and extended length of stay (more than 14 days).Results. Overall 30-day mortality rate was 3.4% and varied by procedure: lobectomy/bilobectomy (2.6%), wedge resection (4.2%), extended lobectomy/bilobectomy (4%), and pneumonectomy (8.5%). By multivariable analysis, increasing age, male sex, increasing comorbidities, and decreased facility volume were associated with higher 30-day mortality. Of patients who underwent lobectomy, 9.1% had an extended length of stay. On multivariable analysis, increasing age, male sex, increasing comorbidities, decreasing facility volume, and right-sided tumors were associated with increased incidence of extended length of stay.Conclusions. Adverse events after the surgical treatment of NSCLC in the NCDB occur with a similar frequency and are predicted by similar patient, procedural, and facility variables as have been identified by more restricted data resources. The NCDB appears to be a valuable resource to study NSCLC in the United States. (C) 2014 by The Society of Thoracic Surgeons