Yiming Li, Jiandong Mei, Zhenyu Yang, Chenglin Guo, Chengwu Liu, Hu Liao, Lin Ma, Feng Lin, Yidan Lin, Yong Yuan, Yunke Zhu, Yuyang Xu, Zheng Liu, Kaidi Li, Yang Hu, Yun Wang, Nan Chen, Zhu Wu, Chuan Li, Liang Xia, Jian Zhou, Xiaolong Zhang, Cheng Shen, Qiang Pu, Lunxu Liu
{"title":"中国一项大型队列研究：I-III期非小细胞肺癌视频辅助胸腔镜手术与开胸肺大部切除术的十年生存结果对比。","authors":"Yiming Li, Jiandong Mei, Zhenyu Yang, Chenglin Guo, Chengwu Liu, Hu Liao, Lin Ma, Feng Lin, Yidan Lin, Yong Yuan, Yunke Zhu, Yuyang Xu, Zheng Liu, Kaidi Li, Yang Hu, Yun Wang, Nan Chen, Zhu Wu, Chuan Li, Liang Xia, Jian Zhou, Xiaolong Zhang, Cheng Shen, Qiang Pu, Lunxu Liu","doi":"10.21037/tlcr-24-150","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Despite the widespread adoption of video-assisted thoracoscopic surgery (VATS) for major lung resection, the 10-year long-term survival outcomes of non-small cell lung cancer (NSCLC) treated with VATS compared with open major lung resection is lacking. The purpose of this study was to analyze the short- and long-term outcomes of VATS <i>vs.</i> open major lung resection for NSCLC.</p><p><strong>Methods: </strong>The perioperative outcomes and long-term survival of p-stage I-III NSCLC patients who underwent major lung resection via VATS <i>vs.</i> open major lung resection in the Western China Lung Cancer Database (WCLCD) between May 2006 and June 2018 were studied using propensity score matching (PSM).</p><p><strong>Results: </strong>Of the 10,167 patients who underwent surgery for lung malignancies, 6,405 patients with stage I-III NSCLC were included in the study, including 4,224 in the VATS group and 2,181 in the open group. PSM resulted in 1,487 patients in both the VATS and open groups. The patients were matched by patient demographics, Charlson comorbidity index (CCI), tumor histology and TNM stage. Compared with open surgery, major lung resection via VATS resulted in less blood loss (median: 50 <i>vs.</i> 100 mL, P<0.001) and a shorter postoperative hospital stay (7.6±6.0 <i>vs.</i> 8.6±4.9 days, P<0.001) but higher total hospital costs (52.5±21.2 <i>vs.</i> 45.0±16.4 kRMB, P<0.001). The matched cohort showed that patients who underwent major lung resection via VATS had better overall survival (OS) and recurrence-free survival (RFS) than did patients who underwent major lung resection via open surgery (5-year survival: 64.9% <i>vs.</i> 57.7%, P<0.001; 5-year RFS: 50.3% <i>vs.</i> 45.3%, P=0.003). Patients who underwent VATS had a better 10-year OS rate (47.8% <i>vs.</i> 42.6%). According to the subgroup analysis, patients with stage II NSCLC who underwent major lung resection via VATS had better OS and RFS (OS: P<0.001; RFS: P=0.004), while there were no significant differences in OS or RFS between stage I and III NSCLC patients.</p><p><strong>Conclusions: </strong>Major lung resection via the VATS should be the preferred surgical option for stage I-III NSCLC patients due to its superior long-term survival outcome and advantages of less blood loss and shorter postoperative hospital stays.</p>","PeriodicalId":23271,"journal":{"name":"Translational lung cancer research","volume":null,"pages":null},"PeriodicalIF":4.0000,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484723/pdf/","citationCount":"0","resultStr":"{\"title\":\"Ten-year survival outcomes of video-assisted thoracic surgery <i>vs.</i> open major lung resection for stage I-III non-small cell lung cancer: a large cohort study in China.\",\"authors\":\"Yiming Li, Jiandong Mei, Zhenyu Yang, Chenglin Guo, Chengwu Liu, Hu Liao, Lin Ma, Feng Lin, Yidan Lin, Yong Yuan, Yunke Zhu, Yuyang Xu, Zheng Liu, Kaidi Li, Yang Hu, Yun Wang, Nan Chen, Zhu Wu, Chuan Li, Liang Xia, Jian Zhou, Xiaolong Zhang, Cheng Shen, Qiang Pu, Lunxu Liu\",\"doi\":\"10.21037/tlcr-24-150\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Despite the widespread adoption of video-assisted thoracoscopic surgery (VATS) for major lung resection, the 10-year long-term survival outcomes of non-small cell lung cancer (NSCLC) treated with VATS compared with open major lung resection is lacking. The purpose of this study was to analyze the short- and long-term outcomes of VATS <i>vs.</i> open major lung resection for NSCLC.</p><p><strong>Methods: </strong>The perioperative outcomes and long-term survival of p-stage I-III NSCLC patients who underwent major lung resection via VATS <i>vs.</i> open major lung resection in the Western China Lung Cancer Database (WCLCD) between May 2006 and June 2018 were studied using propensity score matching (PSM).</p><p><strong>Results: </strong>Of the 10,167 patients who underwent surgery for lung malignancies, 6,405 patients with stage I-III NSCLC were included in the study, including 4,224 in the VATS group and 2,181 in the open group. PSM resulted in 1,487 patients in both the VATS and open groups. The patients were matched by patient demographics, Charlson comorbidity index (CCI), tumor histology and TNM stage. Compared with open surgery, major lung resection via VATS resulted in less blood loss (median: 50 <i>vs.</i> 100 mL, P<0.001) and a shorter postoperative hospital stay (7.6±6.0 <i>vs.</i> 8.6±4.9 days, P<0.001) but higher total hospital costs (52.5±21.2 <i>vs.</i> 45.0±16.4 kRMB, P<0.001). The matched cohort showed that patients who underwent major lung resection via VATS had better overall survival (OS) and recurrence-free survival (RFS) than did patients who underwent major lung resection via open surgery (5-year survival: 64.9% <i>vs.</i> 57.7%, P<0.001; 5-year RFS: 50.3% <i>vs.</i> 45.3%, P=0.003). Patients who underwent VATS had a better 10-year OS rate (47.8% <i>vs.</i> 42.6%). According to the subgroup analysis, patients with stage II NSCLC who underwent major lung resection via VATS had better OS and RFS (OS: P<0.001; RFS: P=0.004), while there were no significant differences in OS or RFS between stage I and III NSCLC patients.</p><p><strong>Conclusions: </strong>Major lung resection via the VATS should be the preferred surgical option for stage I-III NSCLC patients due to its superior long-term survival outcome and advantages of less blood loss and shorter postoperative hospital stays.</p>\",\"PeriodicalId\":23271,\"journal\":{\"name\":\"Translational lung cancer research\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.0000,\"publicationDate\":\"2024-09-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484723/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Translational lung cancer research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.21037/tlcr-24-150\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/9/5 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Translational lung cancer research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/tlcr-24-150","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/5 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：尽管视频辅助胸腔镜手术（VATS）被广泛应用于肺大部切除术，但与开放式肺大部切除术相比，VATS治疗非小细胞肺癌（NSCLC）的10年长期生存结果尚缺乏研究。本研究旨在分析 VATS 与开腹肺大部切除术治疗 NSCLC 的短期和长期疗效：方法：采用倾向评分匹配法（PSM）研究了2006年5月至2018年6月期间在中国西部肺癌数据库（WCLCD）中接受VATS与开胸肺大部切除术的I-III期NSCLC患者的围手术期预后和长期生存情况：在10167名接受肺部恶性肿瘤手术的患者中，6405名I-III期NSCLC患者被纳入研究，其中VATS组4224人，开放组2181人。VATS组和开放组中都有1487名患者接受了PSM治疗。患者的人口统计学特征、夏尔森综合症指数（CCI）、肿瘤组织学和TNM分期均匹配。与开放手术相比，通过 VATS 进行肺大部切除术的失血量更少（中位数为 50 毫升对 100 毫升，Ps：50 mL vs. 100 mL，Pvs. 8.6±4.9天，Pvs. 45.0±16.4 kRMB，Pvs. 57.7%，Pvs. 45.3%，P=0.003）。接受VATS手术的患者10年生存率更高（47.8%对42.6%）。根据亚组分析，通过VATS进行肺大部切除的II期NSCLC患者的OS和RFS更好（OS：PConclusions：通过VATS进行肺大部切除术是I-III期NSCLC患者的首选手术方案，因为它具有长期生存率高、失血少、术后住院时间短等优点。
Ten-year survival outcomes of video-assisted thoracic surgery vs. open major lung resection for stage I-III non-small cell lung cancer: a large cohort study in China.
Background: Despite the widespread adoption of video-assisted thoracoscopic surgery (VATS) for major lung resection, the 10-year long-term survival outcomes of non-small cell lung cancer (NSCLC) treated with VATS compared with open major lung resection is lacking. The purpose of this study was to analyze the short- and long-term outcomes of VATS vs. open major lung resection for NSCLC.
Methods: The perioperative outcomes and long-term survival of p-stage I-III NSCLC patients who underwent major lung resection via VATS vs. open major lung resection in the Western China Lung Cancer Database (WCLCD) between May 2006 and June 2018 were studied using propensity score matching (PSM).
Results: Of the 10,167 patients who underwent surgery for lung malignancies, 6,405 patients with stage I-III NSCLC were included in the study, including 4,224 in the VATS group and 2,181 in the open group. PSM resulted in 1,487 patients in both the VATS and open groups. The patients were matched by patient demographics, Charlson comorbidity index (CCI), tumor histology and TNM stage. Compared with open surgery, major lung resection via VATS resulted in less blood loss (median: 50 vs. 100 mL, P<0.001) and a shorter postoperative hospital stay (7.6±6.0 vs. 8.6±4.9 days, P<0.001) but higher total hospital costs (52.5±21.2 vs. 45.0±16.4 kRMB, P<0.001). The matched cohort showed that patients who underwent major lung resection via VATS had better overall survival (OS) and recurrence-free survival (RFS) than did patients who underwent major lung resection via open surgery (5-year survival: 64.9% vs. 57.7%, P<0.001; 5-year RFS: 50.3% vs. 45.3%, P=0.003). Patients who underwent VATS had a better 10-year OS rate (47.8% vs. 42.6%). According to the subgroup analysis, patients with stage II NSCLC who underwent major lung resection via VATS had better OS and RFS (OS: P<0.001; RFS: P=0.004), while there were no significant differences in OS or RFS between stage I and III NSCLC patients.
Conclusions: Major lung resection via the VATS should be the preferred surgical option for stage I-III NSCLC patients due to its superior long-term survival outcome and advantages of less blood loss and shorter postoperative hospital stays.
期刊介绍：
Translational Lung Cancer Research(TLCR, Transl Lung Cancer Res, Print ISSN 2218-6751; Online ISSN 2226-4477) is an international, peer-reviewed, open-access journal, which was founded in March 2012. TLCR is indexed by PubMed/PubMed Central and the Chemical Abstracts Service (CAS) Databases. It is published quarterly the first year, and published bimonthly since February 2013. It provides practical up-to-date information on prevention, early detection, diagnosis, and treatment of lung cancer. Specific areas of its interest include, but not limited to, multimodality therapy, markers, imaging, tumor biology, pathology, chemoprevention, and technical advances related to lung cancer.
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