Effect of Vein-First vs Artery-First Surgical Technique on Circulating Tumor Cells and Survival in Patients With Non–Small Cell Lung Cancer: A Randomized Clinical Trial and Registry-Based Propensity Score Matching Analysis
| Autor: | Yunke Zhu, Lin Ma, Qiang Li, Shiyou Wei, Qiang Pu, Kejia Zhao, Jintao He, Yun Wang, Ying-Li Kou, Zhu Wu, Bin Jiang, Yi-Dan Lin, Wen-Ping Wang, Qunyou Tan, Chenglin Guo, Zhenyu Yang, Chuan Li, Yong Yuan, Lunxu Liu, Zheng Liu, Jiahan Cheng, Jing Li, Fanyi Gan, Liang Xia, Long-Qi Chen, Chengwu Liu, Guowei Che, Jiandong Mei, Hu Liao, Feng Lin |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Lung Neoplasms Pulmonary Artery 030230 surgery Gastroenterology Disease-Free Survival 03 medical and health sciences 0302 clinical medicine Circulating tumor cell Reward Risk Factors Interquartile range Internal medicine Carcinoma Non-Small-Cell Lung Carcinoma Medicine Humans Prospective Studies Registries Risk factor Pneumonectomy Lung cancer Prospective cohort study Propensity Score Ligation Neoplasm Staging Original Investigation Tomography Emission-Computed Single-Photon business.industry Thoracoscopy Hazard ratio Cancer Arteries Middle Aged medicine.disease Neoplastic Cells Circulating Treatment Outcome Pulmonary Veins 030220 oncology & carcinogenesis Female Surgery Tomography X-Ray Computed business Follow-Up Studies |
| Zdroj: | JAMA Surg |
| Popis: | IMPORTANCE: It is important to develop a surgical technique to reduce dissemination of tumor cells into the blood during surgery. OBJECTIVE: To compare the outcomes of different sequences of vessel ligation during surgery on the dissemination of tumor cells and survival in patients with non–small cell lung cancer. DESIGN, SETTING, AND PARTICIPANTS: This multicenter, randomized clinical trial was conducted from December 2016 to March 2018 with patients with non–small cell lung cancer who received thoracoscopic lobectomy in West China Hospital, Daping Hospital, and Sichuan Cancer Hospital. To further compare survival outcomes of the 2 procedures, we reviewed the Western China Lung Cancer database (2005-2017) using the same inclusion criteria. INTERVENTIONS: Vein-first procedure vs artery-first procedure. MAIN OUTCOMES AND MEASURES: Changes in folate receptor–positive circulating tumor cells (FR(+)CTCs) after surgery and 5-year overall, disease-free, and lung cancer–specific survival. RESULTS: A total of 86 individuals were randomized; 22 patients (25.6%) were younger and 64 (74.4%) older than 60 years. Of these, 78 patients were analyzed. After surgery, an incremental change in FR(+)CTCs was observed in 26 of 40 patients (65.0%) in the artery-first group and 12 of 38 (31.6%) in the vein-first group (P = .003) (median change, 0.73 [interquartile range (IQR), −0.86 to 1.58] FU per 3 mL vs −0.50 [IQR, −2.53 to 0.79] FU per 3 mL; P = .006). Multivariate analysis confirmed that the artery-first procedure was a risk factor for FR(+)CTC increase during surgery (hazard ratio [HR], 4.03 [95% CI, 1.53-10.63]; P = .005). The propensity-matched analysis included 420 patients (210 with vein-first procedures and 210 with artery-first procedures). The vein-first group had significantly better outcomes than the artery-first group for 5-year overall survival (73.6% [95% CI, 64.4%-82.8%] vs 57.6% [95% CI, 48.4%-66.8%]; P = .002), disease-free survival (63.6% [95% CI, 55.4%-73.8%] vs 48.4% [95% CI, 40.0%-56.8%]; P = .001), and lung cancer–specific survival (76.4% [95% CI, 67.6%-85.2%] vs 59.9% [95% CI, 50.5%-69.3%]; P = .002). Multivariate analyses revealed that the artery-first procedure was a prognostic factor of poorer 5-year overall survival (HR, 1.65 [95% CI, 1.07-2.56]; P = .03), disease-free survival (HR, 1.43 [95% CI, 1.01-2.04]; P = .05) and lung cancer–specific survival (HR = 1.65 [95% CI, 1.04-2.61]; P = .03). CONCLUSIONS AND RELEVANCE: Ligating effluent veins first during surgery may reduce tumor cell dissemination and improve survival outcomes in patients with non–small cell lung cancer. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03436329 |
| Databáze: | OpenAIRE |
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