术中先处理动脉还是静脉对NSCLC患者循环肿瘤细胞及生存的影响（IF暂无）
2019-05-12 SCI天天读 SCI天天读
SCI10 May 2019Effect of Vein-First vs Artery-First Surgical Technique on Circulating Tumor Cells and Survival in Patients With Non–Small Cell Lung CancerWei S， Guo C， He J， et al. Effect of Vein-Fir
SCI
10 May 2019
Effect of Vein-First vs Artery-First Surgical Technique on Circulating Tumor Cells and Survival in Patients With Non–Small Cell Lung Cancer
Wei S， Guo C， He J， et al. 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. JAMA Surg 2019：e190972.
Corresponding Author： Lunxu Liu， MD， PhD， FRCS， Department of Thoracic Surgery，West China Hospital， Sichuan University， No. 37， Guoxue Alley， Chengdu，Sichuan 610041， China(lunxu_liu@aliyun.com).
IMPORTANCE 重要性
It is important to develop a surgical technique to reduce dissemination of tumor cells into the blood during surgery.
发展可以减少肿瘤细胞在术中扩散入血的外科技术很重要。
OBJECTIVE 目的
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 设计，设置及参与者
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.
此为一项多中心随机临床试验，于2016年12月至2018年3月在华西医院、大坪医院、四川肿瘤医院接受胸腔镜肺叶切除术的NSCLC患者中进行。为了进一步比较两种手术的生存结果，我们使用相同的纳入标准对中国西部肺癌数据库(2005-2017)进行了回顾性分析。
INTERVENTIONS 干预
Vein-first procedure vs artery-first procedure.
先离断静脉与先离断动脉对比
MAIN OUTCOMES AND MEASURES 主要记过及措施
Changes in folate receptor–positive circulating tumor cells (FR+CTCs) after surgery and 5-year overall， disease-free， and lung cancer–specific survival.
术后叶酸受体阳性循环肿瘤细胞(FR+CTCs)和5年总体无病生存、肺癌特异性生存率的变化。
RESULTS 结果
A total of 86 individuals were randomized； 22 patients (25.6%) were younger and 46 (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 3mL 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).
共随机抽取86人；22例(25.6%)年龄小于60岁，46例(74.4%)年龄大于60岁。最后纳入其中78例患者进行分析。动脉先断组的40名患者中有26例(65.0%)出现FR+CTC增多，而静脉先断组的38名患者中有12例(31.6%)增多（中位变化为0.73 [四分位间距(IQR)， - 0.86 - 1.58] / 3mL FU 相比 - 0.50 [IQR， - 2.53 - 0.79] / 3mL FU；P = .006）。手术后，增量变化FR + ctc在26日的40例(65.0%)artery-first组和12 38 vein-first组(31.6%)(P = .003)(中位数变化，0.73(四分位范围(差)，-0.86到1.58)每3毫升vs-0.50傅傅(IQR-2.53到0.79)/ 3毫升；P = .006)。多因素分析证实先断动脉是导致手术中FR+CTC升高的危险因素(危险率[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).
倾向性匹配分析纳入了420例患者(210例采用静脉先断手术，210例采用动脉先断手术)。静脉先断组的5年总生存率 (73.6%[95%CI， 64.4%-82.8%] 相比 57.6%[95%CI， 48.4%-66.8%])；P = .002)、无病生存率(63.6%(95%CI，55.4% - -73.8%)相比48.4%(95%CI，40.0% - -56.8%))；肺癌特异性生存率(76.4%[95%CI， 67.6%-85.2%] 相比59.9%[95%CI， 50.5%-69.3%]；P = .002)均明显优于动脉先断组。
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).
多因素分析显示，动脉先断手术是5年总体生存率 (HR， 1.65 [95%CI， 1.07-2.56]；P = 03)， 无病生存率(HR， 1.43 [95%CI， 1.01-2.04]；及肺癌特异性生存率(HR = 1.65 [95%CI， 1.04-2.61]；P = 03)较差的预后因素。
CONCLUSIONS AND RELEVANCE 结论与意义
Ligating effluent veins first during surgery may reduce tumor cell dissemination and improve survival outcomes in patients with non–small cell lung cancer.
术中首先离断流出静脉可减少肿瘤细胞的播散，改善NSCLC患者的生存结局。
作者：SCI天天读
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#SCLC患者#
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#静脉#
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#肿瘤细胞#
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#NSCLC患者#
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#循环肿瘤细胞#
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