Long-Term Follow-Up of Patients Receiving Lung-Volume-Reduction Surgery Versus Medical Therapy for Severe Emphysema by the National Emphysema Treatment Trial Research Group

Keith S. Naunheim, Douglas E. Wood, Zab Mohsenifar, Alice L Sternberg, Gerard J. Criner, Malcolm M. DeCamp, Claude C. Deschamps, Fernando J. Martinez, Frank C. Sciurba, James A Tonascia, Alfred P. Fishman

Research output: Contribution to journalArticle

Abstract

Background: The National Emphysema Treatment Trial defined subgroups of patients with severe emphysema in whom lung-volume-reduction surgery (LVRS) improved survival and function at 2 years. Two additional years of follow-up provide valuable information regarding durability. Methods: A total of 1218 patients with severe emphysema were randomized to receive LVRS or medical treatment. We present updated analyses (4.3 versus 2.4 years median follow-up), including 40% more patients with functional measures 2 years after randomization. Results: The intention-to-treat analysis of 1218 randomized patients demonstrates an overall survival advantage for LVRS, with a 5-year risk ratio (RR) for death of 0.86 (p = 0.02). Improvement was more likely in the LVRS than in the medical group for maximal exercise through 3 years and for health-related quality of life (St. George's Respiratory Questionnaire [SGRQ]) through 4 years. Updated comparisons of survival and functional improvement were consistent with initial results for four clinical subgroups of non-high-risk patients defined by upper-lobe predominance and exercise capacity. After LVRS, the upper-lobe patients with low exercise capacity demonstrated improved survival (5-year RR, 0.67; p = 0.003), exercise throughout 3 years (p <0.001), and symptoms (SGRQ) through 5 years (p <0.001 years 1 to 3, p = 0.01 year 5). Upper-lobe-predominant and high-exercise-capacity LVRS patients obtained no survival advantage but were likely to improve exercise capacity (p <0.01 years 1 to 3) and SGRQ (p <0.01 years 1 to 4). Conclusions: Effects of LVRS are durable, and it can be recommended for upper-lobe-predominant emphysema patients with low exercise capacity and should be considered for palliation in patients with upper-lobe emphysema and high exercise capacity.

Original languageEnglish (US)
JournalAnnals of Thoracic Surgery
Volume82
Issue number2
DOIs
StatePublished - Aug 2006
Externally publishedYes

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Pneumonectomy
Emphysema
Exercise
Research
Survival
Therapeutics
Odds Ratio
Intention to Treat Analysis
Random Allocation
Quality of Life

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Long-Term Follow-Up of Patients Receiving Lung-Volume-Reduction Surgery Versus Medical Therapy for Severe Emphysema by the National Emphysema Treatment Trial Research Group. / Naunheim, Keith S.; Wood, Douglas E.; Mohsenifar, Zab; Sternberg, Alice L; Criner, Gerard J.; DeCamp, Malcolm M.; Deschamps, Claude C.; Martinez, Fernando J.; Sciurba, Frank C.; Tonascia, James A; Fishman, Alfred P.

In: Annals of Thoracic Surgery, Vol. 82, No. 2, 08.2006.

Research output: Contribution to journalArticle

Naunheim, Keith S. ; Wood, Douglas E. ; Mohsenifar, Zab ; Sternberg, Alice L ; Criner, Gerard J. ; DeCamp, Malcolm M. ; Deschamps, Claude C. ; Martinez, Fernando J. ; Sciurba, Frank C. ; Tonascia, James A ; Fishman, Alfred P. / Long-Term Follow-Up of Patients Receiving Lung-Volume-Reduction Surgery Versus Medical Therapy for Severe Emphysema by the National Emphysema Treatment Trial Research Group. In: Annals of Thoracic Surgery. 2006 ; Vol. 82, No. 2.
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abstract = "Background: The National Emphysema Treatment Trial defined subgroups of patients with severe emphysema in whom lung-volume-reduction surgery (LVRS) improved survival and function at 2 years. Two additional years of follow-up provide valuable information regarding durability. Methods: A total of 1218 patients with severe emphysema were randomized to receive LVRS or medical treatment. We present updated analyses (4.3 versus 2.4 years median follow-up), including 40{\%} more patients with functional measures 2 years after randomization. Results: The intention-to-treat analysis of 1218 randomized patients demonstrates an overall survival advantage for LVRS, with a 5-year risk ratio (RR) for death of 0.86 (p = 0.02). Improvement was more likely in the LVRS than in the medical group for maximal exercise through 3 years and for health-related quality of life (St. George's Respiratory Questionnaire [SGRQ]) through 4 years. Updated comparisons of survival and functional improvement were consistent with initial results for four clinical subgroups of non-high-risk patients defined by upper-lobe predominance and exercise capacity. After LVRS, the upper-lobe patients with low exercise capacity demonstrated improved survival (5-year RR, 0.67; p = 0.003), exercise throughout 3 years (p <0.001), and symptoms (SGRQ) through 5 years (p <0.001 years 1 to 3, p = 0.01 year 5). Upper-lobe-predominant and high-exercise-capacity LVRS patients obtained no survival advantage but were likely to improve exercise capacity (p <0.01 years 1 to 3) and SGRQ (p <0.01 years 1 to 4). Conclusions: Effects of LVRS are durable, and it can be recommended for upper-lobe-predominant emphysema patients with low exercise capacity and should be considered for palliation in patients with upper-lobe emphysema and high exercise capacity.",
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AU - Naunheim, Keith S.

AU - Wood, Douglas E.

AU - Mohsenifar, Zab

AU - Sternberg, Alice L

AU - Criner, Gerard J.

AU - DeCamp, Malcolm M.

AU - Deschamps, Claude C.

AU - Martinez, Fernando J.

AU - Sciurba, Frank C.

AU - Tonascia, James A

AU - Fishman, Alfred P.

PY - 2006/8

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N2 - Background: The National Emphysema Treatment Trial defined subgroups of patients with severe emphysema in whom lung-volume-reduction surgery (LVRS) improved survival and function at 2 years. Two additional years of follow-up provide valuable information regarding durability. Methods: A total of 1218 patients with severe emphysema were randomized to receive LVRS or medical treatment. We present updated analyses (4.3 versus 2.4 years median follow-up), including 40% more patients with functional measures 2 years after randomization. Results: The intention-to-treat analysis of 1218 randomized patients demonstrates an overall survival advantage for LVRS, with a 5-year risk ratio (RR) for death of 0.86 (p = 0.02). Improvement was more likely in the LVRS than in the medical group for maximal exercise through 3 years and for health-related quality of life (St. George's Respiratory Questionnaire [SGRQ]) through 4 years. Updated comparisons of survival and functional improvement were consistent with initial results for four clinical subgroups of non-high-risk patients defined by upper-lobe predominance and exercise capacity. After LVRS, the upper-lobe patients with low exercise capacity demonstrated improved survival (5-year RR, 0.67; p = 0.003), exercise throughout 3 years (p <0.001), and symptoms (SGRQ) through 5 years (p <0.001 years 1 to 3, p = 0.01 year 5). Upper-lobe-predominant and high-exercise-capacity LVRS patients obtained no survival advantage but were likely to improve exercise capacity (p <0.01 years 1 to 3) and SGRQ (p <0.01 years 1 to 4). Conclusions: Effects of LVRS are durable, and it can be recommended for upper-lobe-predominant emphysema patients with low exercise capacity and should be considered for palliation in patients with upper-lobe emphysema and high exercise capacity.

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