Right-Sided Versus Left-Sided Pneumonectomy After Induction Therapy for Non-Small Cell Lung Cancer.

Autor:	Yang CJ; Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina; Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California., Shah SA; Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina; Harvard Medical School, Boston, Massachusetts., Lin BK; Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina., VanDusen KW; Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina., Chan DY; Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina., Tan WD; Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina., Ranney DN; Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina., Cox ML; Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina., D'Amico TA; Division of Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina., Berry MF; Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, California. Electronic address: berry037@stanford.edu.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2019 Apr; Vol. 107 (4), pp. 1074-1081. Date of Electronic Publication: 2018 Nov 15.
DOI:	10.1016/j.athoracsur.2018.10.009
Abstrakt:	Background: A right-sided pneumonectomy after induction therapy for non-small cell lung cancer (NSCLC) has been shown to be associated with significant perioperative risk. We examined the effect of laterality on long-term survival after induction therapy and pneumonectomy using the National Cancer Data Base. Methods: Perioperative and long-term outcomes of patients who underwent pneumonectomy after induction chemotherapy, with or without radiotherapy, from 2004 to 2014 in the National Cancer Data Base were evaluated using multivariable Cox proportional hazards modeling and propensity score-matched analysis. Results: During the study period, 1,465 patients (right, 693 [47.3%]; left, 772 [52.7%]) met inclusion criteria. Right-sided pneumonectomy was associated with significantly higher 30-day (8.2% [57 of 693] vs 4.2% [32 of 772], p < 0.01) and 90-day mortality (13.6% [94 of 693] vs 7.9% [61 of 772], p < 0.01), and right-sided pneumonectomy was a predictor of higher 90-day mortality (odds ratio, 2.23; p < 0.01). However, overall 5-year survival between right and left pneumonectomy was not significantly different in unadjusted (37.6% [95% confidence interval {CI}, 0.34 to 0.42] vs 35% [95% CI, 0.32 to 0.39], log-rank p = 0.94) or multivariable analysis (hazard ratio, 1.07; 95% CI, 0.92 to 1.25; p = 0.40). A propensity score-matched analysis of 810 patients found no significant differences in 5-year survival between the right-sided versus left-sided groups (34.7% [95% CI, 0.30 to 0.40] vs 34.1%, [95% CI, 0.29 to 0.39], log-rank p = 0.86). Conclusions: In this national analysis, right-sided pneumonectomy after induction therapy was associated with a significantly higher perioperative but not worse long-term mortality compared to a left-sided procedure. (Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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