{"title":"晚期非小细胞肺癌患者的手术与非手术治疗:推荐手术治疗。","authors":"Hui Wang, Di Yang, Yan Lv, Jing Lin, Haibin Wang","doi":"10.1155/2023/4119541","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>There is currently limited evidence for a correlation between the recommended operation and overall survival (OS) in patients with advanced non-small-cell lung cancer (NSCLC).</p><p><strong>Methods: </strong>NSCLC patients with stages III and IV, recommended for operation, were identified in the US National Cancer Institute Surveillance, Epidemiology, and End Results database (SEER).We used propensity score matching (PSM) and multivariable Cox proportional hazards regression to ensure the robustness of our findings. The cumulative rates of death were compared between patients with and without recommended operations using the Kaplan-Meier curves.</p><p><strong>Results: </strong>Operation was recommended for 3331 patients but was not performed in 912 (27.4%) patients (then on-operative group). After PSM, 553 pairs matched. Compared to the nonoperative group, the hazard ratios (HRs) in the operative group were 0.46 (95% CI 0.23-0.95 and <i>p</i>=0.037) in stage IIIA and 0.54 (95% CI 0.42-0.68 and <i>p</i> < 0.001) in stage IVA. However, in stages IIIB, IIIC, and IVB, the recommended operative group was not associated with better OS. The OS was not different in stage IIIA-N2, stage IVA-N1, and stage IVA-N3 patients between groups (<i>p</i>=0.28, <i>p</i>=0.14, and <i>p</i>=0.79, respectively). Moreover, the recommended operative group had better OS than the nonoperative group in stage IIIA-N0 (<i>p</i>=0.00085), stage IIIA-N1 (<i>p</i>=0.009), stage IVA-N0 (<i>p</i> < 0.001), and stage IVA-N2 (<i>p</i>=0.034).</p><p><strong>Conclusion: </strong>Compared to the nonoperative group, recommended operation improved survival in NSCLC patients with stage IIIA-N0, stage IIIA-N1, stage IVA-N0, and stage IVA-N2. However, in stages IIIA-N2, IIIB, IIIC, IVA-N1, IVA-N3, and IVB, recommended operation did not lead to significantly improved survival time.</p>","PeriodicalId":9416,"journal":{"name":"Canadian respiratory journal","volume":null,"pages":null},"PeriodicalIF":2.1000,"publicationDate":"2023-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9851779/pdf/","citationCount":"0","resultStr":"{\"title\":\"Operative versus Nonoperative Treatment in Patients with Advanced Non-Small-Cell Lung Cancer: Recommended for Surgery.\",\"authors\":\"Hui Wang, Di Yang, Yan Lv, Jing Lin, Haibin Wang\",\"doi\":\"10.1155/2023/4119541\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>There is currently limited evidence for a correlation between the recommended operation and overall survival (OS) in patients with advanced non-small-cell lung cancer (NSCLC).</p><p><strong>Methods: </strong>NSCLC patients with stages III and IV, recommended for operation, were identified in the US National Cancer Institute Surveillance, Epidemiology, and End Results database (SEER).We used propensity score matching (PSM) and multivariable Cox proportional hazards regression to ensure the robustness of our findings. The cumulative rates of death were compared between patients with and without recommended operations using the Kaplan-Meier curves.</p><p><strong>Results: </strong>Operation was recommended for 3331 patients but was not performed in 912 (27.4%) patients (then on-operative group). After PSM, 553 pairs matched. Compared to the nonoperative group, the hazard ratios (HRs) in the operative group were 0.46 (95% CI 0.23-0.95 and <i>p</i>=0.037) in stage IIIA and 0.54 (95% CI 0.42-0.68 and <i>p</i> < 0.001) in stage IVA. However, in stages IIIB, IIIC, and IVB, the recommended operative group was not associated with better OS. The OS was not different in stage IIIA-N2, stage IVA-N1, and stage IVA-N3 patients between groups (<i>p</i>=0.28, <i>p</i>=0.14, and <i>p</i>=0.79, respectively). Moreover, the recommended operative group had better OS than the nonoperative group in stage IIIA-N0 (<i>p</i>=0.00085), stage IIIA-N1 (<i>p</i>=0.009), stage IVA-N0 (<i>p</i> < 0.001), and stage IVA-N2 (<i>p</i>=0.034).</p><p><strong>Conclusion: </strong>Compared to the nonoperative group, recommended operation improved survival in NSCLC patients with stage IIIA-N0, stage IIIA-N1, stage IVA-N0, and stage IVA-N2. However, in stages IIIA-N2, IIIB, IIIC, IVA-N1, IVA-N3, and IVB, recommended operation did not lead to significantly improved survival time.</p>\",\"PeriodicalId\":9416,\"journal\":{\"name\":\"Canadian respiratory journal\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2023-01-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9851779/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Canadian respiratory journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1155/2023/4119541\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"RESPIRATORY SYSTEM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Canadian respiratory journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1155/2023/4119541","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
引用次数: 0
摘要
背景:目前关于晚期非小细胞肺癌(NSCLC)患者推荐手术与总生存期(OS)之间相关性的证据有限。方法:在美国国家癌症研究所监测、流行病学和最终结果数据库(SEER)中确定推荐手术的III期和IV期NSCLC患者。我们使用倾向评分匹配(PSM)和多变量Cox比例风险回归来确保我们发现的稳健性。采用Kaplan-Meier曲线比较接受和未接受推荐手术患者的累积死亡率。结果:3331例患者推荐手术，912例(27.4%)患者未行手术。经PSM后，553对配对。与非手术组相比，手术组IIIA期的危险比(hr)为0.46 (95% CI 0.23-0.95, p=0.037)， IVA期的危险比(hr)为0.54 (95% CI 0.42-0.68, p < 0.001)。然而，在IIIB、IIIC和IVB期，推荐的手术组与更好的OS无关。IIIA-N2期、IVA-N1期、IVA-N3期患者的OS组间差异无统计学意义(p=0.28、p=0.14、p=0.79)。推荐术组在IIIA-N0期(p=0.00085)、IIIA-N1期(p=0.009)、IVA-N0期(p < 0.001)、IVA-N2期(p=0.034)的OS均优于非手术组。结论:与非手术组相比，推荐手术可提高IIIA-N0期、IIIA-N1期、IVA-N0期和IVA-N2期NSCLC患者的生存率。然而，在IIIA-N2期、IIIB期、IIIC期、IVA-N1期、IVA-N3期和IVB期，推荐的手术并没有显著改善生存时间。
Operative versus Nonoperative Treatment in Patients with Advanced Non-Small-Cell Lung Cancer: Recommended for Surgery.
Background: There is currently limited evidence for a correlation between the recommended operation and overall survival (OS) in patients with advanced non-small-cell lung cancer (NSCLC).
Methods: NSCLC patients with stages III and IV, recommended for operation, were identified in the US National Cancer Institute Surveillance, Epidemiology, and End Results database (SEER).We used propensity score matching (PSM) and multivariable Cox proportional hazards regression to ensure the robustness of our findings. The cumulative rates of death were compared between patients with and without recommended operations using the Kaplan-Meier curves.
Results: Operation was recommended for 3331 patients but was not performed in 912 (27.4%) patients (then on-operative group). After PSM, 553 pairs matched. Compared to the nonoperative group, the hazard ratios (HRs) in the operative group were 0.46 (95% CI 0.23-0.95 and p=0.037) in stage IIIA and 0.54 (95% CI 0.42-0.68 and p < 0.001) in stage IVA. However, in stages IIIB, IIIC, and IVB, the recommended operative group was not associated with better OS. The OS was not different in stage IIIA-N2, stage IVA-N1, and stage IVA-N3 patients between groups (p=0.28, p=0.14, and p=0.79, respectively). Moreover, the recommended operative group had better OS than the nonoperative group in stage IIIA-N0 (p=0.00085), stage IIIA-N1 (p=0.009), stage IVA-N0 (p < 0.001), and stage IVA-N2 (p=0.034).
Conclusion: Compared to the nonoperative group, recommended operation improved survival in NSCLC patients with stage IIIA-N0, stage IIIA-N1, stage IVA-N0, and stage IVA-N2. However, in stages IIIA-N2, IIIB, IIIC, IVA-N1, IVA-N3, and IVB, recommended operation did not lead to significantly improved survival time.
期刊介绍：
Canadian Respiratory Journal is a peer-reviewed, Open Access journal that aims to provide a multidisciplinary forum for research in all areas of respiratory medicine. The journal publishes original research articles, review articles, and clinical studies related to asthma, allergy, COPD, non-invasive ventilation, therapeutic intervention, lung cancer, airway and lung infections, as well as any other respiratory diseases.
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