Segmentectomy Versus Lobectomy for Radiologically Pure Solid Clinical T1a-bN0M0 Lung Cancer
Segmentectomy Versus Lobectomy for Radiologically Pure Solid Clinical T1a-bN0M0 Lung Cancer
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DOI：
10.1007/s00268-018-4514-0
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发表时间：
2018-08-01
影响因子：
2.6
通讯作者：
Okada, Morihito
中科院分区：
文献类型：
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作者：
Tsubokawa, Norifumi;Tsutani, Yasuhiro;Okada, Morihito
放射学上纯粹的实体瘤的节段切除术仍然存在争议，因为这些肿瘤比那些有磨玻璃阴影的肿瘤更具有恶性侵袭性。本研究旨在探讨纯实体小体积肺癌有意节段切除术的可行性。我们回顾性分析96例临床T1a-bN0M0肺癌放射学纯实体瘤。肿瘤位于中央区或右中叶的患者排除在外。44名接受肺叶切除术的患者与52名接受节段切除术的患者相比。如果确认淋巴结转移或手术切缘不足，则改用节段切除术。采用Cox回归评估影响生存的因素。并进行倾向评分分层分析。8例患者（8%）被确定为非腺癌或鳞状细胞癌的组织学类型。此外，14例（14%）患者出现淋巴结转移。在接受节段切除术的患者中，由于淋巴结转移或手术切缘不足，9例患者（16%）转为肺叶切除术。行节段切除术和肺叶切除术患者的3年无复发生存率分别为84.1和82.2% （P = 0.745）。此外，通过多变量Cox回归分析（风险比1.11；95%可信区间0.40-3.06）确定，即使在倾向评分分层（风险比1.17；95%可信区间0.38-3.65）后，节段切除术和肺叶切除术之间的无复发生存率也无统计学意义。对于临床T1a-bN0M0型肺癌纯实体瘤患者，节段切除术合并术中淋巴结转移评估和足够的手术切缘可能是一种可行的手术方法。
Segmentectomy for radiologically pure solid tumors is still controversial because these tumors are more aggressive in malignancy than those with ground-glass opacity. This study aimed to determine the feasibility of intentional segmentectomy for pure solid small-sized lung cancer.We retrospectively analyzed 96 radiologically pure solid tumors in clinical T1a-bN0M0 lung cancer. Patients whose tumor was located at a central region or right middle lobe were excluded. Forty-four patients who underwent lobectomy were compared with 52 those who underwent segmentectomy. Segmentectomy got converted to lobectomy if lymph node metastases or inadequate surgical margin was confirmed. Factors affecting survival were assessed using Cox regression. Propensity score stratification analysis was also performed.Eight patients (8%) were identified as a histological type other than adenocarcinoma or squamous cell carcinoma. Moreover, 14 patients (14%) displayed lymph node metastasis. Among those who underwent segmentectomy, nine patients (16%) were converted to lobectomy due to lymph node metastasis or inadequate surgical margin. The 3-year recurrence-free survival rates were 84.1 and 82.2% in patients who underwent segmentectomy and lobectomy, respectively (P = 0.745). In addition, the recurrence-free survival was not statistically significant between segmentectomy and lobectomy, as determined via multivariable Cox regression analysis (hazard ratio 1.11; 95% confidence interval 0.40-3.06), even after propensity score stratification (hazard ratio 1.17; 95% confidence interval 0.38-3.65).Segmentectomy with intraoperative assessment of lymph node metastasis and adequate surgical margin may be a feasible surgical procedure for pure solid tumors in clinical T1a-bN0M0 lung cancer.