Sublobar resection is equivalent to lobectomy for clinical stage 1A lung cancer in solid nodules
Sublobar resection is equivalent to lobectomy for clinical stage 1A lung cancer in solid nodules
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DOI：
10.1016/j.jtcvs.2013.09.065
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发表时间：
2014-02-01
影响因子：
6
通讯作者：
Henschke, Claudia I.
中科院分区：
文献类型：
--
作者：
Altorki, Nasser K.;Yip, Rowena;Henschke, Claudia I.
目的：一项随机试验将肺叶切除术确定为早期非小细胞肺癌外科治疗的标准治疗。最近在影像学/分期模式和小肿瘤检测方面的进展再次引起了对早期疾病的肺叶切除术的兴趣。本研究的目的是比较接受肺叶切除术或肺叶下切除术的直径为30 mm或更小的非小细胞肺癌患者的肺癌生存率。方法：我们确定了347例诊断为肺癌的患者，他们接受了肺叶切除术（n = 294）或肺叶切除术（n = 53），在1993年至2011年的国际早期肺癌行动计划中，小细胞肺癌表现为实体结节。采用logistic回归分析确定的未校正P值评估肺叶切除术和肺叶切除术之间术前协变量分布的差异。使用相同的协变量进行倾向评分。使用经调整的P值评估肺叶切除术和肺叶切除术之间相同协变量的分布差异，该P值通过调整倾向评分的logistic回归分析确定。采用Kaplan-Meier法测定肺癌特异性生存期。考克斯生存回归分析用于比较肺叶切除术与肺叶切除术，调整倾向评分，手术和病理结果，调整并按倾向五分位数分层。在347例患者中，53例接受肺叶切除术的患者与294例接受肺叶切除术的患者相比，10年Kaplan-Meier为85%（95%置信区间，80-91）与86%（置信区间，75-96）（P = .86）。考克斯生存分析显示，当调整倾向评分或使用倾向五分位数时，肺叶切除术和肺叶切除术之间没有显着差异（分别为P = 0.62和P = 0.79）。对于那些直径小于等于20毫米的癌症患者，10年生存率为88%。（95%置信区间，82-93）与84%（95%置信区间，73-96）考克斯生存分析显示，采用两种入路行肺叶下切除术与肺叶切除术之间无显著差异结论：在CT筛查肺癌的背景下，肺叶切除术和肺叶切除术对临床IA期非小细胞肺癌患者的生存率相当。
Objectives: A single randomized trial established lobectomy as the standard of care for the surgical treatment of early-stage non-small cell lung cancer. Recent advances in imaging/ staging modalities and detection of smaller tumors have once again rekindled interest in sublobar resection for early-stage disease. The objective of this study was to compare lung cancer survival in patients with non-small cell lung cancer with a diameter of 30 mm or less with clinical stage 1 disease who underwent lobectomy or sublobar resection.Methods: We identified 347 patients diagnosed with lung cancer who underwent lobectomy (n = 294) or sublobar resection (n = 53) for non-small cell lung cancer manifesting as a solid nodule in the International Early Lung Cancer Action Program from 1993 to 2011. Differences in the distribution of the presurgical covariates between sublobar resection and lobectomy were assessed using unadjusted P values determined by logistic regression analysis. Propensity scoring was performed using the same covariates. Differences in the distribution of the same covariates between sublobar resection and lobectomy were assessed using adjusted P values determined by logistic regression analysis with adjustment for the propensity scores. Lung cancer-specific survival was determined by the Kaplan-Meier method. Cox survival regression analysis was used to compare sublobar resection with lobectomy, adjusted for the propensity scores, surgical, and pathology findings, when adjusted and stratified by propensity quintiles.Results: Among 347 patients, 10-year Kaplan-Meier for 53 patients treated by sublobar resection compared with 294 patients treated by lobectomy was 85%(95% confidence interval, 80-91) versus 86%(confidence interval, 75-96) (P = .86). Cox survival analysis showed no significant difference between sublobar resection and lobectomy when adjusted for propensity scores or when using propensity quintiles (P = .62 and P = .79, respectively). For those with cancers 20 mm or less in diameter, the 10-year rates were 88% (95% confidence interval, 82-93) versus 84% (95% confidence interval, 73-96) (P = .45), and Cox survival analysis showed no significant difference between sublobar resection and lobectomy using either approach (P = .42 and P = .52, respectively).Conclusions: Sublobar resection and lobectomy have equivalent survival for patients with clinical stage IA nonsmall cell lung cancer in the context of computed tomography screening for lung cancer.