医学
肺癌
危险系数
置信区间
阶段(地层学)
全肺切除术
比例危险模型
队列
心胸外科
存活率
外科
放射科
内科学
生物
古生物学
作者
Mark Onaitis,Anthony P. Furnary,Andrzej S. Kosinski,Feng Li,Daniel J. Boffa,Betty C. Tong,Patricia A. Cowper,Jeffrey P. Jacobs,Cameron D. Wright,Robert Habib,Joe B. Putnam,Félix G. Fernández
标识
DOI:10.1016/j.athoracsur.2020.01.020
摘要
Background
The oncologic efficacy of segmentectomy is controversial. We compared long-term survival in clinical stage IA (T1N0) Medicare patients undergoing lobectomy and segmentectomy in The Society of Thoracic Surgeons database. Methods
The Society of Thoracic Surgeons General Thoracic Surgery Database was linked to Medicare data in 14,286 lung cancer patients who underwent segmentectomy (n = 1654) or lobectomy (n = 12,632) for clinical stage IA disease from 2002 to 2015. Cox regression was used to create a long-term survival model. Patients were then propensity matched on demographic and clinical variables to derive matched pairs. Results
In Cox modeling segmentectomy was associated with survival similar to lobectomy in the entire cohort (hazard ratio, 1.04; 95% confidence interval, 0.89-1.20; P = .64) and in the matched subcohort. A subanalysis restricted to the 2009 to 2015 population (n = 11,811), when T1a tumors were specified and positron emission tomography results and mediastinal staging procedures were accurately recorded in the database, also showed that segmentectomy and lobectomy continue to have similar survival (hazard ratio, 1.00; 95% confidence interval, 0.87-1.16). Subanalysis of the pathologic N0 patients demonstrated the same results. Conclusions
Lobectomy and segmentectomy for early-stage lung cancer are equally effective treatments with similar survival. Surgeons from The Society of Thoracic Surgeons database appear to be selecting patients appropriately for sublobar procedures.
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