PDF(Pubmed)
Abstract：
UNASSIGNED: There continues to be a rise in the proportion of resectable non-small cell lung cancer (NSCLC) with the recent expansion of criteria for low-dose lung cancer screening. These are increasingly being treated with minimally invasive techniques. Our study aims to compare outcomes of robotic lobectomy (RL) for NSCLC at a National Cancer Institute-designated Comprehensive Cancer Center (NCI-CCC) to those of open lobectomy (OL), video-assisted thoracoscopic lobectomy (VL), or RL as reported in the National Cancer Database (NCDB).
UNASSIGNED: The first 1,021 patients with NSCLC who underwent RL between 2010 and 2020 were matched with peers from the NCDB who had OL, VL, or RL. Matching was performed based on a propensity score calculated by logistic regression using multiple variables. Surgical outcomes included numbers of examined lymph nodes, performance of mediastinal lymphadenectomy, length of stay (LOS), and 30-day mortality. Kaplan-Meier curves and overall survival (OS) were analyzed using log-rank tests.
UNASSIGNED: Most common postoperative complications were persistent air leak, atrial fibrillation, and pneumonia. Median LOS was 4 days, and the 30-day mortality rate was 1% (n=10/1,021). Compared to NCDB patients who underwent OL, NCI-CCC patients had a higher mean number of retrieved lymph nodes (P=0.001), higher rate of mediastinal lymphadenectomy (P<0.001), and shorter median LOS (4 vs. 6 days; P<0.001). There was no difference in 30-day mortality (P=0.176). Kaplan-Meier analyses showed no differences in median OS (log-rank P=0.953) or 5-year OS (P=0.774). Compared to NCDB VL, NCI-CCC patients had a higher nodal yield (P<0.001), higher rates of mediastinal lymphadenectomy (P<0.001), and lower conversion rates (4.1% vs. 13.8%, P<0.001). There were no differences in 30-day mortality (P=0.379) or in median LOS (P=0.351). Kaplan-Meier analyses showed no differences in median OS (P=0.720) or 5-year OS (P=0.735). NCI-CCC patients were also matched with NCDB RL patients and had a higher nodal yield (P<0.001), higher rates of mediastinal lymphadenectomy (P<0.001), and lower conversion rates (4.1% vs. 9.5%; P <0.001). There were no differences in 30-day mortality (P=0.899) or in median LOS (P=0.252). Kaplan-Meier analyses showed no differences in median OS (P=0.484) or 5-year OS (P=0.524).
UNASSIGNED: RL for NSCLC performed in an NCI-CCC appears to have improved perioperative outcomes with comparable long-term OS compared to national benchmarks in OL and VL.
UNASSIGNED: The first 1,021 patients with NSCLC who underwent RL between 2010 and 2020 were matched with peers from the NCDB who had OL, VL, or RL. Matching was performed based on a propensity score calculated by logistic regression using multiple variables. Surgical outcomes included numbers of examined lymph nodes, performance of mediastinal lymphadenectomy, length of stay (LOS), and 30-day mortality. Kaplan-Meier curves and overall survival (OS) were analyzed using log-rank tests.
UNASSIGNED: Most common postoperative complications were persistent air leak, atrial fibrillation, and pneumonia. Median LOS was 4 days, and the 30-day mortality rate was 1% (n=10/1,021). Compared to NCDB patients who underwent OL, NCI-CCC patients had a higher mean number of retrieved lymph nodes (P=0.001), higher rate of mediastinal lymphadenectomy (P<0.001), and shorter median LOS (4 vs. 6 days; P<0.001). There was no difference in 30-day mortality (P=0.176). Kaplan-Meier analyses showed no differences in median OS (log-rank P=0.953) or 5-year OS (P=0.774). Compared to NCDB VL, NCI-CCC patients had a higher nodal yield (P<0.001), higher rates of mediastinal lymphadenectomy (P<0.001), and lower conversion rates (4.1% vs. 13.8%, P<0.001). There were no differences in 30-day mortality (P=0.379) or in median LOS (P=0.351). Kaplan-Meier analyses showed no differences in median OS (P=0.720) or 5-year OS (P=0.735). NCI-CCC patients were also matched with NCDB RL patients and had a higher nodal yield (P<0.001), higher rates of mediastinal lymphadenectomy (P<0.001), and lower conversion rates (4.1% vs. 9.5%; P <0.001). There were no differences in 30-day mortality (P=0.899) or in median LOS (P=0.252). Kaplan-Meier analyses showed no differences in median OS (P=0.484) or 5-year OS (P=0.524).
UNASSIGNED: RL for NSCLC performed in an NCI-CCC appears to have improved perioperative outcomes with comparable long-term OS compared to national benchmarks in OL and VL.
摘要：
随着最近低剂量肺癌筛查标准的扩展，可切除的非小细胞肺癌（NSCLC）的比例继续上升。这些越来越多地使用微创技术进行治疗。我们的研究旨在比较在美国国家癌症研究所指定的综合癌症中心（NCI-CCC）的机器人肺叶切除术（RL）与开放式肺叶切除术（OL）的结果，胸腔镜肺叶切除术(VL),或国家癌症数据库（NCDB）中报告的RL。
■2010年至2020年间接受RL的前1,021例NSCLC患者与患有OL的NCDB同行相匹配，VL,或RL。基于使用多个变量通过逻辑回归计算的倾向得分进行匹配。手术结果包括检查的淋巴结数量，纵隔淋巴结清扫术的表现，停留时间(LOS)30天死亡率使用对数秩检验分析Kaplan-Meier曲线和总生存期(OS)。
■术后最常见的并发症是持续漏气，心房颤动,和肺炎。LOS中位数是4天,30天死亡率为1%(n=10/1,021)。与接受OL的NCDB患者相比，NCI-CCC患者的平均淋巴结检索数较高（P=0.001），纵隔淋巴结清扫率较高（P<0.001），和较短的中位数LOS（4与6天；P<0.001）。30天死亡率无差异（P=0.176）。Kaplan-Meier分析显示中位OS（log-rankP=0.953）或5年OS（P=0.774）无差异。与NCDBVL相比，NCI-CCC患者的淋巴结产率较高(P<0.001)，纵隔淋巴结清扫率较高（P<0.001），和较低的转化率（4.1%与13.8%,P<0.001)。30天死亡率（P=0.379）或中位LOS（P=0.351）无差异。Kaplan-Meier分析显示中位OS（P=0.720）或5年OS（P=0.735）无差异。NCI-CCC患者也与NCDBRL患者相匹配，并且具有更高的淋巴结产率（P<0.001），纵隔淋巴结清扫率较高（P<0.001），和较低的转化率（4.1%与9.5%;P<0.001)。30天死亡率（P=0.899）或中位LOS（P=0.252）无差异。Kaplan-Meier分析显示中位OS（P=0.484）或5年OS（P=0.524）无差异。
■与OL和VL的国家基准相比，在NCI-CCC中对NSCLC进行的RL似乎改善了围手术期结局，具有可比的长期OS。
■2010年至2020年间接受RL的前1,021例NSCLC患者与患有OL的NCDB同行相匹配，VL,或RL。基于使用多个变量通过逻辑回归计算的倾向得分进行匹配。手术结果包括检查的淋巴结数量，纵隔淋巴结清扫术的表现，停留时间(LOS)30天死亡率使用对数秩检验分析Kaplan-Meier曲线和总生存期(OS)。
■术后最常见的并发症是持续漏气，心房颤动,和肺炎。LOS中位数是4天,30天死亡率为1%(n=10/1,021)。与接受OL的NCDB患者相比，NCI-CCC患者的平均淋巴结检索数较高（P=0.001），纵隔淋巴结清扫率较高（P<0.001），和较短的中位数LOS（4与6天；P<0.001）。30天死亡率无差异（P=0.176）。Kaplan-Meier分析显示中位OS（log-rankP=0.953）或5年OS（P=0.774）无差异。与NCDBVL相比，NCI-CCC患者的淋巴结产率较高(P<0.001)，纵隔淋巴结清扫率较高（P<0.001），和较低的转化率（4.1%与13.8%,P<0.001)。30天死亡率（P=0.379）或中位LOS（P=0.351）无差异。Kaplan-Meier分析显示中位OS（P=0.720）或5年OS（P=0.735）无差异。NCI-CCC患者也与NCDBRL患者相匹配，并且具有更高的淋巴结产率（P<0.001），纵隔淋巴结清扫率较高（P<0.001），和较低的转化率（4.1%与9.5%;P<0.001)。30天死亡率（P=0.899）或中位LOS（P=0.252）无差异。Kaplan-Meier分析显示中位OS（P=0.484）或5年OS（P=0.524）无差异。
■与OL和VL的国家基准相比，在NCI-CCC中对NSCLC进行的RL似乎改善了围手术期结局，具有可比的长期OS。
