达芬奇机器人与电视胸腔镜辅助手术治疗Ⅰ期肺腺癌远期结果的倾向性评分匹配研究

Long-term outcome of robotic versus video-assisted thoracic surgery for stageⅠ lung adenocarcinoma:A propensity score matching study

目的比较Ⅰ期肺腺癌机器人手术(robot-assisted thoracic surgery,RATS)与电视胸腔镜手术(video-assisted thoracic surgery,VATS)的疗效差异。方法纳入2012年1月至2018年12月291例患者,并分为两组:RATS组,125例;VATS组,166例;用倾向性评分匹配后得出114对数据:RATS组男45例、女69例,年龄(62±9)岁;VATS组男44例、女70例,年龄(62±8)岁。比较两组总生存率(OS)和无病生存率(DFS)的差异,进行单变量和多变量分析。结果RATS组与VATS组术后带管时间及住院时间差异无统计学意义(P>0.05)。RATS比VATS能清扫更多的淋巴结(P=0.000),术中出血量(P=0.000)和术后24 h胸腔引流量(P=0.001)更少。RATS组与VATS组1年、3年和5年生存率、平均生存时间差异均无统计学意义(P<0.05)。RATS组1年无病生存率(94.1%vs.95.6%)、3年无病生存率(92.6%vs.75.2%)、5年无病生存率(92.6%vs.68.4%)及平均无病生存时间[(78±2)个月vs.(63±4)个月]明显优于VATS组(P<0.05)。单因素分析结果显示,淋巴结清扫组数是患者生存状况的影响因素。患者无病生存状况的影响因子包括手术方式、肿瘤直径、淋巴结清扫组数、淋巴结清扫数量。多因素分析显示生存状况与无进展状况均无独立影响因素。结论RATS治疗Ⅰ期肺腺癌患者术后生存状况与VATS手术无差异,RATS拥有更好的无病生存状况。

Objective To compare the the effectiveness of robot-assisted thoracic surgery(RATS)with videoassisted thoracic surgery(VATS),in stageⅠlung adenocarcinoma.Methods From January 2012 to December 2018,291 patients were included.The patients were allocated into two groups including a RATS group with 125 patients and a VATS group with 166 patients.Two cohorts(RATS,VATS)of clinical stageⅠlung adenocarcinoma patients were matched by propensity score.Then there were 114 patients in each group(228 patients in total).There were 45 males and 69 females at age of 62±9 years in the RATS group;44 males,70 females at age of 62±8 years in the VATS group.Overall survival(OS)and disease-free survival(DFS)were assessed.Univariate and multivariate analyses were performed to identify factors associated with the outcomes.Results Compared with the VATS group,the RATS group got less blood loss(P<0.05)and postoperative drainage(P<0.05)with a statistical difference.There was no statistical difference in drainage time(P>0.05)or postoperative hospital stay(P>0.05)between the two groups.The RATS group harvested more stations and number of the lymph nodes with a statistical difference(P<0.05).There was no statistical difference in 1-year, 3-year and 5-year OS and mean survival time (P>0.05). While there was a statistical difference in DFS betweenthe two groups (1-year DFS: 94.1% vs. 95.6%;3-year DFS: 92.6% vs. 75.2%;5-year DFS: 92.6% vs. 68.4%, P<0.05;mean DFStime: 78 months vs. 63 months, P<0.05) between the two groups. The univariate analysis found that the number of thelymph nodes dissection was the prognostic factor for OS, and tumor diameter, surgical approach, stations and number ofthe lymph nodes dissection were the prognostic factors for DFS. However, multivariate analysis found that there wasno independent risk factor for OS, but the tumor diameter and surgical approach were independently associated with DFS.Conclusion There is no statistical difference in OS between the two groups, but the RATS group gets better DFS.