PDF(Pubmed)
Abstract：
UNASSIGNED: Current National Comprehensive Cancer Network guidelines recommend definitive chemoradiation rather than surgery for patients with locally advanced clinical stage T3 and N2 (stage IIIB) lung cancer involving the chest wall. The data supporting this recommendation are controversial. We studied whether surgery confers a survival advantage over definitive chemoradiation in the National Cancer Database.
UNASSIGNED: We identified all patients with clinical stage T3 and N2 lung cancer in the National Cancer Database from 2004 to 2017 who underwent a lobectomy with en bloc chest wall resection and compared them with patients with clinical stage T3 and N2 lung cancer who had definitive chemoradiation. We used propensity score matching to minimize confounding by indication while excluding patients with tumors in the upper lobes to exclude Pancoast tumors. We used 1:1 propensity score matching and Kaplan-Meir survival analyses to estimate associations.
UNASSIGNED: Of 4467 patients meeting all inclusion/exclusion criteria, 210 (4.49%) had an en bloc chest wall resection. Patients undergoing surgical resection were younger (mean age = 60.3 ± 10.3 years vs 67.5 ± 10.4 years; P < .001) and had more adenocarcinoma (59.0% vs 44.5%; P < .001) but were otherwise similar in terms of sex (37.1% female vs 42.0%; P = .167) and race (Whites 84.3% vs 84.0%; P = .276) compared with the definitive chemoradiation group. After resection, there was an unadjusted 30- and 90-day mortality rate of 3.3% and 9.5%, respectively. A substantial survival benefit with surgical resection persisted after propensity score matching (log-rank P < .001).
UNASSIGNED: In this large observational study, we found that in select patients, en bloc chest wall resection for locally advanced clinical stage T3 and N2 lung cancer was associated with improved survival compared with definitive chemoradiation. National Comprehensive Cancer Network guidelines should be revisited.
UNASSIGNED: We identified all patients with clinical stage T3 and N2 lung cancer in the National Cancer Database from 2004 to 2017 who underwent a lobectomy with en bloc chest wall resection and compared them with patients with clinical stage T3 and N2 lung cancer who had definitive chemoradiation. We used propensity score matching to minimize confounding by indication while excluding patients with tumors in the upper lobes to exclude Pancoast tumors. We used 1:1 propensity score matching and Kaplan-Meir survival analyses to estimate associations.
UNASSIGNED: Of 4467 patients meeting all inclusion/exclusion criteria, 210 (4.49%) had an en bloc chest wall resection. Patients undergoing surgical resection were younger (mean age = 60.3 ± 10.3 years vs 67.5 ± 10.4 years; P < .001) and had more adenocarcinoma (59.0% vs 44.5%; P < .001) but were otherwise similar in terms of sex (37.1% female vs 42.0%; P = .167) and race (Whites 84.3% vs 84.0%; P = .276) compared with the definitive chemoradiation group. After resection, there was an unadjusted 30- and 90-day mortality rate of 3.3% and 9.5%, respectively. A substantial survival benefit with surgical resection persisted after propensity score matching (log-rank P < .001).
UNASSIGNED: In this large observational study, we found that in select patients, en bloc chest wall resection for locally advanced clinical stage T3 and N2 lung cancer was associated with improved survival compared with definitive chemoradiation. National Comprehensive Cancer Network guidelines should be revisited.
摘要：
■当前的国家综合癌症网络指南建议对局部晚期临床T3期和N2期（IIIB期）涉及胸壁的肺癌患者进行明确的放化疗而不是手术。支持这一建议的数据是有争议的。我们在国家癌症数据库中研究了手术是否比确定性放化疗具有生存优势。
■我们在2004年至2017年的国家癌症数据库中确定了所有接受肺叶切除术和整体胸壁切除术的T3和N2临床期肺癌患者，并将其与接受确定性放化疗的T3和N2临床期肺癌患者进行了比较。我们使用倾向评分匹配来减少适应症的混淆，同时排除上叶肿瘤患者以排除Pancoast肿瘤。我们使用1：1倾向评分匹配和Kaplan-Meir生存分析来估计关联。
■在符合所有纳入/排除标准的4467名患者中，210例（4.49％）进行了整体胸壁切除术。接受手术切除的患者年龄较小（平均年龄=60.3±10.3岁vs67.5±10.4岁；P<.001），腺癌较多（59.0％vs44.5％；P<.001），但在性别（37.1％女性vs42.0％；P=.167）和种族（白人84.3％vs84.0％；P=.276）方面与确定性放化疗组相似。切除后,未经调整的30天和90天死亡率分别为3.3%和9.5%，分别。在倾向评分匹配（log-rankP<.001）后，手术切除的实质性生存益处仍然存在。
■在这项大型观察研究中，我们发现，在选定的患者中，与确定性放化疗相比,局部晚期临床T3和N2期肺癌的整体胸壁切除术与生存率提高相关.国家综合癌症网络指南应该重新审视。
■我们在2004年至2017年的国家癌症数据库中确定了所有接受肺叶切除术和整体胸壁切除术的T3和N2临床期肺癌患者，并将其与接受确定性放化疗的T3和N2临床期肺癌患者进行了比较。我们使用倾向评分匹配来减少适应症的混淆，同时排除上叶肿瘤患者以排除Pancoast肿瘤。我们使用1：1倾向评分匹配和Kaplan-Meir生存分析来估计关联。
■在符合所有纳入/排除标准的4467名患者中，210例（4.49％）进行了整体胸壁切除术。接受手术切除的患者年龄较小（平均年龄=60.3±10.3岁vs67.5±10.4岁；P<.001），腺癌较多（59.0％vs44.5％；P<.001），但在性别（37.1％女性vs42.0％；P=.167）和种族（白人84.3％vs84.0％；P=.276）方面与确定性放化疗组相似。切除后,未经调整的30天和90天死亡率分别为3.3%和9.5%，分别。在倾向评分匹配（log-rankP<.001）后，手术切除的实质性生存益处仍然存在。
■在这项大型观察研究中，我们发现，在选定的患者中，与确定性放化疗相比,局部晚期临床T3和N2期肺癌的整体胸壁切除术与生存率提高相关.国家综合癌症网络指南应该重新审视。
