Effect of Vein-First vs Artery-First Surgical Technique on Circulating Tumor Cells and Survival in Patients With Non–Small Cell Lung Cancer

作者：Shiyou Wei, Chenglin Guo, Jintao He, Qunyou Tan, Jiandong Mei, Zhenyu Yang, Chengwu Liu, Qiang Pu, Lin Ma, Yong Yuan, Feng Lin, Yunke Zhu, Hu Liao, Wenping Wang, Zheng Liu, Qiang Li, Bin Jiang, Chuan Li, Liang Xia, Kejia Zhao, Fanyi Gan, Jiahan Cheng, Zhu Wu, Yun Wang, Yi‐Dan Lin, Yingli Kou, Guowei Che, Longqi Chen, Jing Li, Lunxu Liu · 发表于：JAMA Surgery · 年份：2019 · DOI：10.1001/jamasurg.2019.0972 · 被引用次数：88 · 研究领域：Cancer Cells and Metastasis、Angiogenesis and VEGF in Cancer、Lung Cancer Diagnosis and Treatment

Importance: It is important to develop a surgical technique to reduce dissemination of tumor cells into the blood during surgery. Objective: 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: 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. Interventions: Vein-first procedure vs artery-first procedure. Main Outcomes and Measures: Changes in folate receptor-positive circulating tumor cells (FR+CTCs) after surgery and 5-year overall, disease-free, and lung cancer-specific survival. Results: 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 arte...