一种基于回顾性分析的早期非小细胞肺癌手术方式的风险评估模型  

A retrospective-analysis based risk assessment model for the surgical selection of early stage NSCLC

作　　者：李献帅 陈献国[1] 楼洋[1] 许博[1] 徐小义 

机构地区：[1]金华市中心医院心胸外科,浙江金华321000

出　　处：《实用肿瘤杂志》2017年第6期515-520,共6页Journal of Practical Oncology

摘　　要：目的创建1个风险评估模型,对行肺叶或亚肺叶切除的早期非小细胞肺癌患者进行分类,找出最适宜的手术方式。方法统计2012年至2016年行肺叶或亚肺叶(肺段或肺楔形)切除术的非小细胞肺癌患者。使用多变量Logistic回归模型,确定肺叶切除患者围手术期30 d死亡率的相关风险因素。建立1个评分系统预测围手术期30 d死亡率。结果共纳入3 356例患者。其中1 773例(52.8%)行肺叶切除术,1 281例(38.2%)行肺楔形切除术,302例(9.0%)行肺段切除术。年龄、慢性阻塞性肺疾病、脑血管意外或短暂性脑缺血发作史、生活依赖状态、过去6个月吸烟史以及手术入路(微创或开放)等指标为相关风险因素。风险值>5分患者肺叶切除术组围手术期死亡率高于肺段切除术组和肺楔形切除术组(3.1%vs 1.6%、0.5%,均P<0.01)。结论对于风险值≤5分的早期非小细胞肺癌患者,行肺叶切除术的围手术期风险未超过亚肺叶切除术;但对于风险值>5分的患者,行肺叶切除术围手术期的死亡率高于行亚肺叶切除术患者。本研究建立的风险评估模型预测不同术式围手术期死亡率,以期指导外科医师选择更合适的手术方式。Objective To establish a risk assessment model to facilitate the surgical selection of early stage nonsmall-cell lung cancer（ NSCLC）,based on the classification of patients who underwent lobectomy or sublobar resection.Methods The 2012-2016 database was used for NSCLC patients who underwent a lobectomy or sublobar resection（ either segmentectomy or wedge resection）.A multivariable logistic regression model was utilized to determine factors associated with 30-day mortality.An associated scoring system was developed to predict the perioperative mortality within 30 d.Results Of the 3 356 patients who met study criteria,1 773（ 52.8%） cases underwent lobectomy,1 281（ 38.2%） cases underwent wedge resection,and 302（ 9.0%） cases underwent segmentectomy.Related risk factors include age,chronic obstructive pulmonary disease,previous cerebrovascular accident or transient ischemic attack,functional status,smoking history in the past 6 months,and surgical approaches（ minimally invasive or open surgery）.For patients with risk scores higher than 5,the perioperative mortality rate in the lobectomy group（ 3.1%） was higher than that of the segmentectomy group（ 1.6%） or pulmonary wedge resection group（ 0.5%,P 0.01）.Conclusions Among patients with a risk score of 5 or less,lobectomy confers no additional perioperative risk over sublobar resection.However,for patients with higher risk scores,their perioperative mortality of pulmonary lobectomy was significantly higher than that of sublobar resection.The risk assessment model established in this study can predict the perioperative mortality caused by different surgical approaches,which guide surgeons to select the most appropriate surgical method.

关 键 词：癌 非小细胞肺/外科学 肺切除术/方法 LOGISTIC模型 危险性评估 

分 类 号：R734.2[医药卫生—肿瘤] R730.56[医药卫生—临床医学]