Characteristics and risk factors of recurrence in clinical stage I non-small cell lung cancer patients undergoing anatomic segmentectomy
Characteristics and risk factors of recurrence in clinical stage I non-small cell lung cancer patients undergoing anatomic segmentectomy
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DOI：
10.1007/s11748-020-01338-x
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发表时间：
2020-03-20
影响因子：
1.2
通讯作者：
Tsuchida, Masanori
中科院分区：
文献类型：
--
作者：
Koike, Terumoto;Nakamura, Akihiro;Tsuchida, Masanori
目的虽然肺叶切除术是治疗小体积非小细胞肺癌（NSCLC）的标准手术方式，但由于各种原因，也有部分患者需要行肺段切除术。本研究的目的是探讨接受肺段切除术的早期非小细胞肺癌患者复发的特点和危险因素。方法回顾性分析179例接受肺段切除术的临床I期NSCLC患者。术前因素分析采用对数秩检验进行单变量分析。采用考克斯比例风险回归模型进行多变量分析，以确定复发的独立风险因素。对于显著性因素，通过受试者工作特征（ROC）分析确定最佳截断点。结果随访51个月，18例复发，5例局部复发（其中2例仅切缘复发），9例远处复发，4例局部和远处均复发。多变量和ROC分析确定放射学实体瘤大小与1.5 cm的临界点作为复发的独立危险因素。实体大小< 1.5 cm组中有3例患者（n = 119）复发，其中2例患者手术切缘复发，而实体大小≥ 1.5 cm组中有15例患者（n = 60）复发。结论：在低风险亚组患者中，应谨慎决定肺段切除术的适应症，应仔细考虑待切除的肺段，以确保适当的手术切缘，因为他们可能具有相对较高的手术切缘复发风险，尽管风险降低。
Objective Although lobectomy is the standard surgical procedure for small-sized non-small cell lung cancer (NSCLC), segmentectomy has been performed for various reasons. The aim of this study was to investigate the characteristics of and risk factors for recurrence in early-stage NSCLC patients undergoing segmentectomy. Methods We retrospectively reviewed 179 patients with clinical stage I NSCLC who underwent segmentectomy. Preoperative factors were analyzed using the log-rank test for univariate analyses. Multivariate analyses were performed using a Cox proportional hazards regression model to identify independent risk factors for recurrence. For the significant factors, optimal cutoff points were determined by receiver operating characteristic (ROC) analysis. Results During the follow-up period of 51 months, 18 patients developed recurrence; 5 had locoregional (including 2 with margin recurrences only), 9 had distant, and 4 had both locoregional and distant recurrence. Multivariate and ROC analysis identified radiologic solid tumor size with a cutoff point of 1.5 cm as an independent risk factor for recurrence. Three patients in the solid size < 1.5 cm group (n = 119) developed recurrence, 2 of whom had surgical margin recurrence, compared to 15 patients in the solid size >= 1.5 cm group (n = 60). Conclusions The indication for segmentectomy should be decided upon with caution, and the segments to be resected should be carefully considered to secure an appropriate surgical margin in this low-risk subgroup of patients because they may have a relatively higher risk of surgical margin recurrence, despite being at decreased risk.