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

Autor: Shivani A. Shah, Keith W. VanDusen, Chi-Fu Jeffrey Yang, Wendy D. Tan, Morgan L. Cox, Thomas A. D'Amico, Mark F. Berry, David N. Ranney, Belle K. Lin, Derek Y. Chan
Rok vydání: 2019
Předmět:
Adult
Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Lung Neoplasms
Databases
Factual
medicine.medical_treatment
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
Risk Assessment
Disease-Free Survival
Cohort Studies
03 medical and health sciences
Pneumonectomy
0302 clinical medicine
Text mining
Carcinoma
Non-Small-Cell Lung
medicine
Humans
Propensity Score
Lung cancer
Aged
Proportional Hazards Models
Retrospective Studies
business.industry
Proportional hazards model
Induction chemotherapy
Chemoradiotherapy
Induction Chemotherapy
Perioperative
Middle Aged
Prognosis
medicine.disease
Survival Analysis
Neoadjuvant Therapy
Surgery
Radiation therapy
030228 respiratory system
Multivariate Analysis
Female
Non small cell
Cardiology and Cardiovascular Medicine
business
Zdroj: The Annals of Thoracic Surgery. 107:1074-1081
ISSN: 0003-4975
Popis: 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.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.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], p0.01) and 90-day mortality (13.6% [94 of 693] vs 7.9% [61 of 772], p0.01), and right-sided pneumonectomy was a predictor of higher 90-day mortality (odds ratio, 2.23; p0.01). 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).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.
Databáze: OpenAIRE
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