ObjectiveTo compare the efficacy of three surgical approaches, including percutaneous transluminal angioplasty (PTA), PTA+bare metal stent (BMS), and Rotarex+PTA+drug coated balloon (DCB), in treating femoropopliteal artery lesions in arteriosclerosis obliterans (ASO), and to explore the prognostic factors of femoropopliteal artery lesions in ASO. MethodsA retrospective analysis was conducted on 314 patients with femoropopliteal artery lesions in ASO who were treated in the Department of Vascular and Thyroid Surgery in the First Affiliated Hospital of Xinjiang Medical University from March 2018 to March 2024. inverse probability of treatment weighting was used to balance the baseline characteristics of the three groups. The clinical examination, imaging examination, and ankle-brachial index (ABI) results of the three groups at 3 months, 12 months, and 24 months after surgery were compared. Log-rank test was used to compare the incidence of all-cause mortality (ACM) and major adverse limb events (MALEs) among the three groups, and Cox proportional hazards regression model was used to analyze the prognostic factors of femoropopliteal artery lesions in ASO. ResultsA total of 314 patients with ASO femoropopliteal artery lesions were enrolled, comprising 153 cases in the PTA group, 89 cases in the PTA+BMS group, and 72 cases in the Rotarex+PTA+DCB group. After inverse probability of treatment weighting based on propensity scores, baseline characteristics were balanced across all groups (all P>0.05). Postoperative follow-up results demonstrated the following patency rates: at 3 months, 58.4% (87/149) for the PTA group, 79.5% (66/83) for the PTA+BMS group, and 87.5% (63/72) for the Rotarex+PTA+DCB group; at 12 months, 78.0% (60/79), 68.3% (43/63), and 80.0% (44/55), respectively; and at 24 months, 98.1% (52/53), 89.7% (35/39), and 100.0% (43/43), respectively. The Rotarex+PTA+DCB group exhibited significantly superior patency rates, claudication distances, ankle-brachial index (ABI), and Rutherford classification compared to both the PTA and PTA+BMS groups at 3 months (P<0.05). Furthermore, the Rotarex+PTA+DCB group showed lower incidence of ACM/MALEs compared to the other two groups (χ2=18.70, P<0.001). Survival analysis revealed that the Rotarex+PTA+DCB group had significantly better survival outcomes compared to the PTA+BMS group (χ2=14.27, P<0.001) and the PTA group (χ2=3.92, P=0.016). Cox proportional hazards regression analysis identified elevated red cell distribution width (RDW) as an independent risk factor for ACM/MALEs following endovascular therapy in ASO patients, with a relative risk of 1.006 [95%CI (1.002, 1.011), P=0.006]. ConclusionsThe Rotarex+PTA+DCB demonstrate superior outcomes compared to both the PTA and PTA+BMS in terms of patency rate, claudication distance, ABI, and Rutherford classification at 3 months postoperatively, along with the better survival. Furthermore, elevated RDW may serve as a prognostic factor for adverse outcomes in patients with ASO femoropopliteal artery lesions.
Objective To compare the survival outcomes in patients with epidermal growth factor receptor (EGFR)-mutated stageⅠ invasive lung adenocarcinoma who underwent lobectomy, sublobar resection, and sublobar resection plus postoperative targeted therapy, and to evaluate whether the combined strategy yield outcomes similar to lobectomy in a real-world setting. MethodsThis retrospective cohort study enrolled consecutive patients who underwent video-assisted thoracoscopic radical resection at West China Hospital, Sichuan University, between November 2017 and April 2025. All patients had postoperative pathologic stageⅠ invasive lung adenocarcinoma according to the 8th edition of the TNM stage, and confirmed EGFR mutations. Patients were categorized into three groups: a lobectomy alone group (lobectomy group), a sublobar resection alone group (sublobar resection group), and a sublobar resection plus postoperative targeted therapy group (combined group). Inverse probability of treatment weighting (IPTW) was applied to balance the baseline characteristics. Overall survival (OS) and recurrence-free survival (RFS), defined as time to first recurrence with death treated as censoring, were compared. ResultsA total of 450 patients was enrolled with 157 in the lobectomy group, 240 in the sublobar resection group, and 53 in the combined group. Among patients who did not receive any adjuvant therapy, OS was similar between the sublobar group and the lobectomy group, whereas sublobar resection had significantly poor RFS. In comparisons between the lobectomy group and the combined group, neither OS nor RFS differed significantly before or after IPTW adjustment. ConclusionsAmong patients with EGFR-mutated stageⅠ lung adenocarcinoma, sublobar resection is associated with poor RFS when compared with lobectomy. The combined strategy shows no statistically significant survival difference versus lobectomy. Prospective studies with rigorous design are warranted to further validate the above findings.