Optimal resection rate for lung cancer in the UK: how high should we go?
lung cancer
thoracic surgery
Journal
BMJ open respiratory research
ISSN: 2052-4439
Titre abrégé: BMJ Open Respir Res
Pays: England
ID NLM: 101638061
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
received:
01
10
2020
accepted:
05
07
2021
entrez:
30
7
2021
pubmed:
31
7
2021
medline:
25
11
2021
Statut:
ppublish
Résumé
The optimal resection rate for institutions managing early-stage primary lung cancer is not known. Whether the prognosis of patients who do not proceed to operation is determined by their comorbidities for which they were deemed at prohibitively high-operative risk, or disease progression, is uncertain. We investigated the outcomes of patients with early-stage lung cancer who were considered for surgical management. We reviewed the outcomes of consecutive patients who were considered for resection of early-stage primary lung cancer at Oxford University Hospitals National Health Service Foundation Trust between 2012 and 2017. Between 29 November 2012 and 31 March 2017, 467 consecutive patients underwent resection with curative intent for primary lung cancer (operative group), while 81 patients were deemed resectable but either inoperable or did not wish to proceed to operation (non-operative group). Reason for not proceeding to resection was cardiovascular in 16 patients (19.8%), respiratory in 21 (25.9%), cardiorespiratory in 11 (13.6%), performance status in 8 (9.9%) and patient choice in 25 (30.9%) patients. Sixty-six patients (81.5%) received an alternative radical treatment. Median follow-up was 169 weeks (IQR 119-246 weeks) in the operative group and 118 weeks (IQR 74-167 weeks) in the non-operative group. Median survival of patients with early-stage lung cancer who did not proceed to operation was 2.5 years; median survival of patients undergoing lung cancer resection was undefined (p<0.0001). Lung cancer was documented as directly or indirectly leading to or contributing to death in 40 patients (76.9%). In 11 patients, the cause of death was due to comorbidities (21.2%). Patients turned down for operation in a high-resection rate UK unit have limited survival due to lung cancer progression. We conclude that 'optimal' resection rates may not have been reached in the UK even in high-resection rate centres.
Sections du résumé
BACKGROUND
The optimal resection rate for institutions managing early-stage primary lung cancer is not known. Whether the prognosis of patients who do not proceed to operation is determined by their comorbidities for which they were deemed at prohibitively high-operative risk, or disease progression, is uncertain. We investigated the outcomes of patients with early-stage lung cancer who were considered for surgical management.
METHODS
We reviewed the outcomes of consecutive patients who were considered for resection of early-stage primary lung cancer at Oxford University Hospitals National Health Service Foundation Trust between 2012 and 2017.
RESULTS
Between 29 November 2012 and 31 March 2017, 467 consecutive patients underwent resection with curative intent for primary lung cancer (operative group), while 81 patients were deemed resectable but either inoperable or did not wish to proceed to operation (non-operative group). Reason for not proceeding to resection was cardiovascular in 16 patients (19.8%), respiratory in 21 (25.9%), cardiorespiratory in 11 (13.6%), performance status in 8 (9.9%) and patient choice in 25 (30.9%) patients. Sixty-six patients (81.5%) received an alternative radical treatment. Median follow-up was 169 weeks (IQR 119-246 weeks) in the operative group and 118 weeks (IQR 74-167 weeks) in the non-operative group. Median survival of patients with early-stage lung cancer who did not proceed to operation was 2.5 years; median survival of patients undergoing lung cancer resection was undefined (p<0.0001). Lung cancer was documented as directly or indirectly leading to or contributing to death in 40 patients (76.9%). In 11 patients, the cause of death was due to comorbidities (21.2%).
CONCLUSIONS
Patients turned down for operation in a high-resection rate UK unit have limited survival due to lung cancer progression. We conclude that 'optimal' resection rates may not have been reached in the UK even in high-resection rate centres.
Identifiants
pubmed: 34326151
pii: 8/1/e000771
doi: 10.1136/bmjresp-2020-000771
pmc: PMC8323385
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Thorax. 2010 Oct;65 Suppl 3:iii1-27
pubmed: 20940263
Eur J Cardiothorac Surg. 2008 Jan;33(1):77-82
pubmed: 17983763
Lung Cancer. 2020 Feb;140:1-7
pubmed: 31838168
Eur Respir J. 2009 Jul;34(1):17-41
pubmed: 19567600
Lancet Oncol. 2019 Nov;20(11):1493-1505
pubmed: 31521509
Lung Cancer. 2019 Aug;134:16-24
pubmed: 31319976
EClinicalMedicine. 2020 Nov 30;31:100663
pubmed: 33554075
Ann Thorac Surg. 2011 Aug;92(2):445-8
pubmed: 21704295
N Engl J Med. 1982 May 27;306(21):1259-62
pubmed: 7070445
Eur J Cardiothorac Surg. 2020 Apr 1;57(4):771-778
pubmed: 31651938
Br J Cancer. 2020 Aug;123(3):471-479
pubmed: 32390010
Eur J Cancer. 2012 Jan;48(1):54-60
pubmed: 21871792