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- Title
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.
- Authors
Wei, Shiyou; Guo, Chenglin; He, Jintao; Tan, Qunyou; Mei, Jiandong; Yang, Zhenyu; Liu, Chengwu; Pu, Qiang; Ma, Lin; Yuan, Yong; Lin, Feng; Zhu, Yunke; Liao, Hu; Wang, Wenping; Liu, Zheng; Li, Qiang; Jiang, Bin; Li, Chuan; Xia, Liang; Zhao, Kejia
- Abstract
<bold>Importance: </bold>It is important to develop a surgical technique to reduce dissemination of tumor cells into the blood during surgery.<bold>Objective: </bold>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.<bold>Design, Setting, and Participants: </bold>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.<bold>Interventions: </bold>Vein-first procedure vs artery-first procedure.<bold>Main Outcomes and Measures: </bold>Changes in folate receptor-positive circulating tumor cells (FR+CTCs) after surgery and 5-year overall, disease-free, and lung cancer-specific survival.<bold>Results: </bold>A total of 86 individuals were randomized; 22 patients (25.6%) were younger and 64 (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 3 mL 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). 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). 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).<bold>Conclusions and Relevance: </bold>Ligating effluent veins first during surgery may reduce tumor cell dissemination and improve survival outcomes in patients with non-small cell lung cancer.<bold>Trial Registration: </bold>ClinicalTrials.gov identifier: NCT03436329.
- Publication
JAMA Surgery, 2019, Vol 154, Issue 5, pe190972
- ISSN
2168-6254
- Publication type
journal article
- DOI
10.1001/jamasurg.2019.0972