背景:肺癌的临床分期对治疗计划和预后有影响。我们试图确定不准确的临床分期(相对于病理),识别不准确的风险因素,并评估不准确性对生存的关联。我们假设不准确的分期与低生存率有关。
方法:在这项回顾性队列研究中,在美国国家癌症数据库中,2004~2020年间接受手术切除而未接受新辅助治疗的非小细胞肺癌的成年患者按照临床分期(相对于病理分期)的准确性进行分类.多变量模型用于确定不准确的危险因素。还分析了不准确性与总生存率之间的关联。
结果:我们确定了255,598例肺癌患者,包括84,543例(33.1%)分期不准确的患者。分期不准确与更高的肿瘤有关,节点,转移阶段(T-类别3:比值比[OR]=1.2,95%置信区间[CI]1.15-1.28;N-类别2:OR=2.6,95%CI2.47-2.79),评估的淋巴结数量更多,和更广泛的切除(扩大肺叶切除术/双叶切除术:OR=1.3,95%CI1.20-1.37;肺切除术:OR=1.6,95%CI1.54-1.74)。接受机器人手术的患者不太可能被错误地分期(OR=0.89,95%CI0.852-0.939)。不准确的分期与更差的总生存率相关(55.4%的准确率与55.4%的准确率,P<0.001)。在多变量Cox模型中,不准确的分期也与较差的生存率相关(风险比[HR]=1.3,95%CI1.29-1.33)。“分期不足”(路径>临床)和“分期过度”(临床>路径)均与低生存率相关。
结论:1/3的肺癌手术患者临床分期(相对于病理分期)不准确。不准确与低生存率有关。质量改进措施应侧重于提高临床分期的准确性。
BACKGROUND: Clinical staging in lung cancer has implications for treatment planning and prognosis. We sought to determine the rate of inaccurate clinical stage (relative to pathologic), identify risk factors for inaccuracy, and evaluate the association of inaccuracy on survival. We hypothesized that inaccurate staging was associated with poor survival.
METHODS: In this retrospective cohort study, adult patients who received surgical resection without neoadjuvant treatment for nonsmall cell lung cancer from 2004 to 2020 in the National Cancer Database were categorized by accuracy of clinical stage (relative to pathologic stage). Multivariate models were used to determine risk factors for inaccuracy. The association between inaccuracy and overall survival was also analyzed.
RESULTS: We identified 255,598 patients with lung cancer, including 84,543 patients (33.1%) who were inaccurately staged. Stage inaccuracy was associated with higher tumor, node, metastasis stage (T-category 3: odds ratio [OR] = 1.2, 95% confidence interval [CI] 1.15-1.28; N-category 2: OR = 2.6, 95% CI 2.47-2.79), greater quantity of lymph nodes evaluated, and more extensive resection (extended lobectomy/bilobectomy: OR = 1.3, 95% CI 1.20-1.37; pneumonectomy: OR = 1.6, 95% CI 1.54-1.74). Patients undergoing robotic surgery were less likely to be inaccurately staged (OR = 0.89, 95% CI 0.852-0.939). Inaccurate staging was associated with worse overall survival (5-y 67.5% accurate versus 55.4% inaccurate, P < 0.001). Inaccurate staging was also associated with worse survival in a multivariate Cox model (hazard ratio [HR] = 1.3, 95% CI 1.29-1.33). Both \"understaging\" (path > clinical) and \"overstaging\" (clinical > path) were associated with inferior survival.
CONCLUSIONS: Inaccurate clinical stage (relative to pathologic) occurs in one-third of patients receiving surgery for lung cancer. Inaccuracy is associated with poor survival. Quality improvement initiatives should focus on improving clinical staging accuracy.