Comments on “Lobe-specific Lymph Node Dissection in Clinical Stage IA Solid-dominant Non-small-cell Lung Cancer: A Propensity Score Matching Study”
Comments on “Lobe-specific Lymph Node Dissection in Clinical Stage IA Solid-dominant Non-small-cell Lung Cancer: A Propensity Score Matching Study”
复制标题
对“临床 IA 期实性显性非小细胞肺癌中肺叶特异性淋巴结清扫：倾向评分匹配研究”的评论
DOI：
10.1016/j.cllc.2021.06.014
复制
发表时间：
2022
影响因子：
3.6
通讯作者：
Okamoto Tatsuro
中科院分区：
文献类型：
--
作者：
Takamori Shinkichi;Takada Kazuki;Shimokawa Mototsugu;Okamoto Tatsuro
临床实践要点·在接受根治性肺切除的早期非小细胞肺癌(NSCLC)患者中，胸部淋巴清扫所需的范围一直存在争议。在目前的研究中，作者得出结论，在无病生存率(DFS)和总体生存率(OS)方面，临床IA期NSCLC患者接受叶特异性淋巴清扫术(LSND)与系统淋巴清扫术(SND)的疗效相似。然而，这项研究包括大量被审查的案例和不充分的后续行动，这可能导致LSND组的DFS和OS被高估。作者报道了LSND组和SND组的5年生存率分别为96.7%和92.0%，与历史对照组相比，这两组的5年生存率都非常高。考虑到早期切除的非小细胞肺癌复发的少数病例，本研究中60.8个月的中位随访期似乎也很短。此外，值得注意的是，大多数患者患有编码表皮生长因子受体(EGFR)基因突变的非小细胞肺癌。复发的EGFR突变阳性非小细胞肺癌患者可能受益于EGFR酪氨酸激酶抑制剂的治疗，并获得更长的生存时间。可能需要一个包括EGFR突变状态的更好的分层分析来比较LSND组和SND组之间的OS。综上所述，赵勇等人。调查了一个对胸外科医生和肿瘤学家都至关重要的话题。然而，未来的研究，包括随机对照试验，必须致力于就早期非小细胞肺癌淋巴清扫的临床影响得出明确的结论。
Clinical Practice Points•In patients with early-stage non-small-cell lung cancer (NSCLC) patients who undergo curative lung resection, the required extent of thoracic lymphadenectomy has been debated. In the current study, the authors conclude that lobe-specific lymph node dissection (LSND) administered to patients with clinical stage IA NSCLC is similarly efficient as systematic lymph node dissection (SND) in terms of disease-free survival (DFS) and overall survival (OS). However, the study includes a substantial number of censored cases and an insufficient follow-up period, which may result in overestimated DFS and OS of the LSND group. The authors reported 96.7% and 92.0% 5-year survival rates of the LSND and SND groups, respectively, which are highly superior compared with the historical control. The median follow-up of 60.8 months in the present study also seems short considering the small number of cases of recurrence of resected early-stage NSCLC. In addition, it is notable that most patients had NSCLC with mutations in the gene encoding the epidermal growth factor receptor (EGFR). Patients with recurrence of EGFR mutation-positive NSCLC may benefit from treatment with EGFR tyrosine kinase inhibitors and achieve longer survival. A more well-stratified analysis that includes EGFR mutation status may be required to compare OS between the LSND and SND groups. In conclusion, Zhao Y et al. investigated a topic that is critically important to thoracic surgeons as well as to oncologists. However, future studies, including randomized controlled trials, must aim to arrive at definitive conclusions concerning the clinical impact of lymph node dissection in early-stage NSCLC.