Dataset Information

Video-Assisted Thoracoscopic Lobectomy Versus Stereotactic Body Radiotherapy Treatment for Early-Stage Non-Small Cell Lung Cancer: A Propensity Score-Matching Analysis.

ABSTRACT:

Background

Compared the overall outcomes of video-assisted thoracoscopic surgery (VATS) versus stereotactic body radiotherapy (SBRT) for stage I-II non-small cell lung cancer (NSCLC).

Methods

We retrospectively compared overall survival (OS), cancer-specific survival (CSS), locoregional control (LRC), and disease-free survival (DFS) at our institution between January 2012 and December 2016. Propensity score-matching was performed to reduce patient selection bias based on age, gender, Karnofsky performance score, Charlson comorbidity index, pulmonary function, and tumor diameter.

Results

A total of 567 patients treated with SBRT (n = 109) or surgery (n = 458) were included. Of those, 104 patients were matched for further analyses. Median follow-up was 44 months. At 3 and 5 years, OS was 88.6 and 79.9% for SBRT, and 94.2 and 91.6% for surgery (p = 0.097). There were no differences noted in 5-year CSS (83.7 vs. 91.6%, respectively; p = 0.270). The cumulative incidence of LRC at 3 and 5 years was comparable (93.5 and 93.5% vs. 94.0 and 85.9%, respectively; p = 0.621). Differences in the rates of disease-free survival at 5 years were not statistically significant (79.0 and 80.5%, respectively; p = 0.624).

Conclusions

This propensity score-matching analysis suggests that SBRT can be an alternative option to VATS lobectomy for stage I-II NSCLC.

SUBMITTER: Dong B

PROVIDER: S-EPMC7683774 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Publications

Video-Assisted Thoracoscopic Lobectomy <i>Versus</i> Stereotactic Body Radiotherapy Treatment for Early-Stage Non-Small Cell Lung Cancer: A Propensity Score-Matching Analysis.

Dong Baiqiang B Zhu Xuan X Shu Zekai Z Ji Yongling Y Lu Fangxiao F Wang Jin J Chen Ming M

Frontiers in oncology 20201110

<h4>Background</h4>Compared the overall outcomes of video-assisted thoracoscopic surgery (VATS) <i>versus</i> stereotactic body radiotherapy (SBRT) for stage I-II non-small cell lung cancer (NSCLC).<h4>Methods</h4>We retrospectively compared overall survival (OS), cancer-specific survival (CSS), locoregional control (LRC), and disease-free survival (DFS) at our institution between January 2012 and December 2016. Propensity score-matching was performed to reduce patient selection bias based on ag ...[more]

PMID: 33244457

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Project description:ObjectiveTo determine the learning curve for double-port video-assisted thoracoscopic (VATS) lung segmentectomy performed by the same surgical team in our center.MethodsWe retrospectively collected clinical data from 193 patients who underwent double-port video-assisted thoracoscopic lung segmentectomy from March 2017 to March 2023. The operative time (OT) was analyzed using the cumulative sum (CUSUM) method, and two stages of the learning curve were obtained. Propensity score matching (PSM) was performed for age, sex, underlying disease, and single-segment resection via radius matching. The OT, estimated amount of intraoperative blood loss, and other complications were analyzed.ResultsWe generated a graph of the CUSUM of the OT and found that the learning curve could be differentiated into two stages: the learning stage (1st to 95th surgery) and the proficiency stage (96th to 193rd surgery). Before PSM, there were significant differences in the OT, extent of lymph node station dissection, amount of drainage on the day of surgery, amount of drainage on the first postoperative day, estimated amount of intraoperative blood loss, and length of hospital stay after surgery. There were no significant differences in the average amount of drainage 3 days after surgery, postoperative tube time, or number of intraoperative revolutions. However, after PSM, there were significant differences in the OT, number of lymph node stations removed, amount of drainage on the day of surgery, and amount of drainage on the first postoperative day. There were no significant differences in the estimated amount of intraoperative blood loss, length of hospital stay after surgery, average amount of drainage for 3 days after surgery, postoperative tube time, or number of intraoperative revolutions.ConclusionIn our center, the learning curve for double-port video-assisted thoracoscopic lung segmentectomy transitions from the learning stage to the proficiency stage when the number of surgical cases reaches 95. There were significant differences in the OT, number of lymph node stations removed, amount of drainage on the day of surgery, and amount of drainage on the first postoperative day.

Project description:BackgroundIt is unclear whether hybrid video-assisted thoracoscopic surgery (VATS) sleeve lobectomy (SL) could be an alternative to thoracotomy SL for non-small cell lung cancer (NSCLC) treatment. The aim of the study is to investigate the safety and efficacy of hybrid VATS SL.MethodsWe collected 112 patients who received hybrid VATS SL or thoracotomy SL for primary treatment of NSCLC at Liaoning Cancer Hospital & Institute from November 2016 to September 2021. Perioperative and survival data were collected, and retrospective analysis was conducted on 91 thoracotomy and 21 hybrid VATS SL patients to evaluate the safety and efficacy of two approaches. Propensity score matching (PSM) was used to minimize selection bias. The Kaplan-Meier method was applied to compare overall survival (OS) and recurrence-free survival (RFS). Follow-up data were obtained by outpatient clinical visit and nurse-led telephone.ResultsA total of 112 patients were included in this study, including thoracotomy patients (n=91) and hybrid VATS patients (n=21). In the non-match analysis, the baseline data of patients was similar between the two groups, except regarding the receipt of neoadjuvant therapy (P=0.087). After PSM (2:1), a total of 39 thoracotomy patients and 19 hybrid VATS patients were enrolled. The baseline variables were quite similar in both groups. In the hybrid group, the number of lymph nodes (25.9±8.5 vs. 32.9±9.7, P<0.01) and positive lymph nodes (3.7±2.9 vs. 5.6±4.0, P=0.045) were significantly higher than those in the thoracotomy group. The hybrid group was associated with significantly shorter postoperative hospital stay (9.5±3.5 vs. 7.3±2.9, P=0.021) and chest tube duration time (6.6±3.1 vs. 5.3±1.5, P=0.031). No statistical difference in complications, reoperation, and recurrence were observed between the hybrid VATS SL and thoracotomy SL (P=1.0, P=1.0, P=0.472). The 30- and 90-day mortalities showed no differences between approaches (2.6% vs. 0%, P=1.0; 5.1% vs. 5.3%, P=1.0). No significant differences were found between thoracotomy and hybrid VATS SL in 3-year OS (P=0.614) and 3-year RFS (P=0.750).ConclusionsHybrid VATS SL lobectomy may be a safe and feasible approach associated with similar oncologic prognosis and better postoperative recovery compared with thoracotomy SL for NSCLC treatment.

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Project description:ObjectivesThe aim of this study is to compare the postoperative complications, perioperative course, and survival among patients from the multicentric Spanish Video-assisted Thoracic Surgery Group database who received video-assisted thoracic surgery lobectomy or video-assisted thoracic surgery anatomic segmentectomy.MethodsFrom December 2016 to March 2018, a total of 2250 patients were collected from 33 centers. Overall analysis (video-assisted thoracic surgery lobectomy = 2070; video-assisted thoracic surgery anatomic segmentectomy = 180) and propensity score-matched adjusted analysis (video-assisted thoracic surgery lobectomy = 97; video-assisted thoracic surgery anatomic segmentectomy = 97) were performed to compare postoperative results. Kaplan-Meier and competing risks method were used to compare survival.ResultsIn the overall analysis, video-assisted thoracic surgery anatomic segmentectomy showed a lower incidence of respiratory complications (relative risk, 0.56; confidence interval, 0.37-0.83; P = .002), lower postoperative prolonged air leak (relative risk, 0.42; 95% confidence interval, 0.23-0.78; P = .003), and shorter median postoperative stay (4.8 vs 6.2 days; P = .004) than video-assisted thoracic surgery lobectomy. After propensity score-matched analysis, prolonged air leak remained significantly lower in video-assisted thoracic surgery anatomic segmentectomy (relative risk, 0.33; 95% confidence interval, 0.12-0.89; P = .02). Kaplan-Meier and competing risk curves showed no differences during the 3-year follow-up (median follow-up in months: 24.4; interquartile range, 20.8-28.3) in terms of overall survival (hazard ratio, 0.73; 95% confidence interval, 0.45-1.7; P = .2), tumor progression-related mortality (subdistribution hazard ratio, 0.41; 95% confidence interval, 0.11-1.57; P = .2), and disease-free survival (subdistribution hazard ratio, 0.73; 95% confidence interval, 0.35-1.51; P = .4) between groups.ConclusionsVideo-assisted thoracic surgery segmentectomy showed results similar to lobectomy in terms of postoperative outcomes and midterm survival. In addition, a lower incidence of prolonged air leak was found in patients who underwent video-assisted thoracic surgery anatomic segmentectomy.