Lobectomy Versus Segmentectomy in Radiologically Pure Solid Small-Sized Non-Small Cell Lung Cancer
Lobectomy Versus Segmentectomy in Radiologically Pure Solid Small-Sized Non-Small Cell Lung Cancer
复制标题
DOI：
10.1016/j.athoracsur.2015.10.048
复制
发表时间：
2016-04-01
影响因子：
4.6
通讯作者：
Tsuchida, Masanori
中科院分区：
文献类型：
--
作者：
Koike, Terumoto;Kitahara, Akihiko;Tsuchida, Masanori
背景由于非小细胞肺癌（NSCLC）的浸润性病理特征，其有限切除的适应证一直存在争议。本研究旨在比较非小细胞肺癌患者行肺叶切除术和肺段切除术后的结局。我们回顾性分析了251例接受肺叶切除术或肺段切除术的放射学纯实性cT 1a NO MO NSCLC患者，并使用倾向评分方法匹配采用两种手术技术治疗的患者的术前特征。使用对数秩检验比较总生存期（OS）和无病生存期（DFS）曲线，并通过McNemar检验评价生存期差异。采用多因素考克斯比例风险回归模型分析术前因素和手术方式，以确定OS和DFS差的独立预测因素。在倾向评分匹配的肺叶切除术和肺段切除术组（每组87例患者）中，5年和10年OS率分别为85%和84%，66%和63%; 5年和10年DFS率分别为80%和77%，64%和58%。通过对数秩检验，两组之间的OS或DFS无显著差异，通过McNemar检验，3年、5年或7年OS或DFS也无显著差异。虽然年龄、吸烟状况、肺功能和癌胚抗原被确定为OS和DFS的重要预测因素，但手术方式未被确定。在放射学纯实体小型非小细胞肺癌患者中，肺叶切除术和肺段切除术后的肿瘤学结局相似。(C)2016胸外科医师协会
Background. The indication for limited resection of radiologically pure solid non-small cell lung cancer (NSCLC) is controversial owing to its invasive pathologic characteristics. This study was performed to compare the outcomes after lobectomy and segmentectomy in these NSCLC patients.Methods. We retrospectively reviewed 251 patients with radiologically pure solid cT1a NO MO NSCLC who underwent lobectomy or segmentectomy, and the preoperative characteristics of the patients treated with the two operative techniques were matched using propensity score methods. Overall survival (OS) and disease-free survival (DFS) curves were compared using the log rank test, and differences in survival were also evaluated by the McNemar test. The preoperative factors and surgical procedure were analyzed with the multivariate Cox proportional hazards regression model to identify independent predictors of poor OS and DFS.Results. In the propensity score matched lobectomy and segmentectomy groups (87 patients per group), the 5-year and 10-year OS rates were 85% versus 84% and 66% versus 63%, respectively; and the 5-year and 10-year DFS rates were 80% versus 77% and 64% versus 58%, respectively. There were no significant differences between the two groups in OS or DFS by the log rank test, and also no significant differences in 3-year, 5-year, or 7-year OS or DFS by the McNemar test. Although age, smoking status, pulmonary function, and carcinoembryonic antigen were identified as significant predictors of both OS and DFS, the surgical procedure was not identified.Conclusions. Similar oncologic outcomes after lobectomy and segmentectomy were indicated among patients with radiologically pure solid small-sized NSCLC. (C) 2016 by The Society of Thoracic Surgeons