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. Data are available upon reasonable request. Anonymised data on the patient dataset used in this study are stored according to NHS data storage guidelines. If you would like to access these data, please contact the corresponding author.

中文翻译：

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英国肺癌的最佳切除率：我们应该走多高？

背景 管理早期原发性肺癌的机构的最佳切除率尚不清楚。不进行手术的患者的预后是否取决于他们被认为具有极高手术风险的合并症或疾病进展，尚不确定。我们调查了考虑接受手术治疗的早期肺癌患者的结局。方法 我们回顾了 2012 年至 2017 年牛津大学医院国家健康服务基金会信托考虑接受早期原发性肺癌切除术的连续患者的结果。结果 2012 年 11 月 29 日至 2017 年 3 月 31 日期间，467 名连续患者接受了切除术原发性肺癌的治愈意图（手术组），而81名患者被认为可以切除但不能手术或不想进行手术（非手术组）。未进行手术切除的原因是心血管 16 例 (19.8%)、呼吸 21 例 (25.9%)、心肺 11 例 (13.6%)、体力状态 8 例 (9.9%) 和患者选择 25 例 (30.9%) . 66 名患者 (81.5%) 接受了替代性根治性治疗。手术组的中位随访时间为 169 周（IQR 119-246 周），非手术组为 118 周（IQR 74-167 周）。未进行手术的早期肺癌患者的中位生存期为 2.5 年；接受肺癌切除术的患者的中位生存期不确定（p<0.0001）。肺癌被记录为直接或间接导致或导致 40 名患者 (76.9%) 死亡。在 11 名患者中，死亡原因是合并症 (21.2%)。结论 在高切除率英国单位拒绝手术的患者由于肺癌进展而生存有限。我们得出的结论是，即使在高切除率中心，英国也可能未达到“最佳”切除率。可应合理要求提供数据。本研究中使用的患者数据集上的匿名数据根据 NHS 数据存储指南进行存储。如果您想访问这些数据，请联系相应的作者。我们得出的结论是，即使在高切除率中心，英国也可能未达到“最佳”切除率。可应合理要求提供数据。本研究中使用的患者数据集上的匿名数据根据 NHS 数据存储指南进行存储。如果您想访问这些数据，请联系相应的作者。我们得出的结论是，即使在高切除率中心，英国也可能未达到“最佳”切除率。可应合理要求提供数据。本研究中使用的患者数据集上的匿名数据根据 NHS 数据存储指南进行存储。如果您想访问这些数据，请联系相应的作者。