OBJECTIVES Recent guidelines for the treatment of lung cancer include comprehensive lists of recommendations for pre-operative risk evaluation, staging, and surgery. Our aim was to evaluate whether the implementation of these in a population-based real-world setting would improve outcomes. MATERIALS AND METHODS All patients diagnosed with primary lung cancer in Central Finland and Ostrobothnia between January 1, 2006, and December 31, 2017, were identified from registry data (N = 2116), including patients who underwent surgical resection (n = 303). Data were divided into two periods, old and modern, according to which international guidelines were followed. RESULTS Between surgical patients of the old and modern periods, significant changes occurred in the rate of pre-operative stair climbing tests (3.7 % vs. 68.6 %, p < 0.001), the use of positron emission computed tomography (18.7 % vs. 75.7 %, p < 0.001), and invasive staging (3.7 % vs. 26.0 %, p < 0.001). In surgery, the rate of VATS (2.2 % vs. 81.1 %, p < 0.001), segmentectomy (1.5 % vs. 27.2 %, p < 0.001), and extended resections (5.2 % vs. 13.6 %, p = 0.015) increased. However, between these periods, the rate of pneumonectomy decreased from 7.5 % to 1.2 % (p = 0.005) and bilobectomy from 9.0%-1.8% (p = 0.004). The overall resection rate increased from 10.5%-19.7 %, mainly due to a higher number of high-risk patients (12.7 % vs. 34.3 %, p < 0.001). Patients faced fewer major complications (21.6 % vs. 8.9 %, p = 0.002) and had shorter hospital stays (9 days, IQR 7-11 vs. 5 days, IQR 3-7; p < 0.001). In the modern period, patients underwent adjuvant therapy less often than in the old period (35.1 % vs. 22.5 %, p = 0.015). Recurrence-free 5-year survival rate improved, however, from 64.0%-76.8% (p < 0.001). CONCLUSIONS The introduction of guideline-based modern patient evaluation and treatment was associated with improved short- and long-term outcomes of lung cancer surgery.

中文翻译：

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一项基于现实世界的基于指南的肺癌治疗可改善短期和长期结果以及切除率：一项基于人群的研究。

目标最近的肺癌治疗指南包括术前风险评估，分期和手术的综合性建议清单。我们的目的是评估在以人口为基础的现实世界中实施这些措施是否会改善结果。材料与方法从登记数据（N = 2116）中识别出2006年1月1日至2017年12月31日期间在芬兰中部和博物癖地区诊断为原发性肺癌的所有患者，包括接受手术切除的患者（n = 303）。数据分为两个时期，即旧时期和现代时期，并遵循国际准则。结果在古代和现代时期的手术患者之间，术前爬楼梯测试的比率发生了显着变化（3.7％对68.6％，p <0.001），使用正电子发射计算机断层扫描（18.7％vs. 75.7％，p <0.001）和侵入性分期（3.7％vs. 26.0％，p <0.001）。在手术中，VATS（2.2％vs. 81.1％，p <0.001），节段切除术（1.5％vs. 27.2％，p <0.001）和扩大切除率（5.2％vs. 13.6％，p = 0.015）增加。然而，在这两个时期之间，肺切除术的比例从7.5％降低至1.2％（p = 0.005），双叶切除术的比例从9.0％-1.8％（p = 0.004）。总体切除率从10.5％-19.7％增加，这主要是由于高危患者的数量增加（12.7％与34.3％，p <0.001）。患者面临的主要并发症更少（21.6％vs. 8.9％，p = 0.002）并且住院时间更短（9天，IQR 7-11比5天，IQR 3-7； p <0.001）。在现代时期，患者接受辅助治疗的频率要低于老年时期（35。1％和22.5％，p = 0.015）。但是，无复发的5年生存率从64.0％-76.8％提高了（p <0.001）。结论引入基于指南的现代患者评估和治疗与改善肺癌手术的短期和长期结果相关。