Video-assisted thoracic surgery versus open thoracotomy for non-small-cell lung cancer: a propensity score analysis based on a multi-institutional registry

Comparative long-term survival and oncological outcomes for patients with non-small-cell lung cancer (NSCLC) who undergo video-assisted thoracic surgery (VATS) or conventional open lobectomy remain uncertain. We conducted a multi-institutional propensity-matched study to stratify potential differences in these outcomes. We established a multi-institutional registry for 4312 patients with NSCLC who underwent lobectomy between 2001 and 2008 from eight institutions in the People's Republic of China. Age, gender, histological type and tumour staging were entered into a non-parsimonious multivariable logistic regression model to assess long-term survival outcomes. The predicted probability derived from the logistic equation was used as the propensity score for each individual. Based on similar propensity scores, we matched 1458 of the 1700 patients who underwent VATS lobectomy with 1458 of the 2612 patients who underwent open lobectomy and compared their long-term survival outcomes. The mean age of the 2916 matched patients was 59 (standard deviation = 11) years. After propensity-matching, VATS and open lobectomy patients were similar in regards to important prognostic variables. Three prognostic factors were independently associated with improved survival in the multivariate analysis: age < 60 (P < 0.001), female gender (P = 0.013) and pathological staging (P < 0.001). Patients who underwent VATS vs open lobectomy had similar long-term survival (P = 0.07). The current propensity score analysis suggests that well-matched patients with NSCLC who underwent standardized VATS lobectomy had similar long-term survival outcomes when compared with those who underwent open lobectomy.