Lobe-Specific Nodal Dissection for Clinical Stage I and II NSCLC: Japanese Multi-Institutional Retrospective Study Using a Propensity Score Analysis
Lobe-Specific Nodal Dissection for Clinical Stage I and II NSCLC: Japanese Multi-Institutional Retrospective Study Using a Propensity Score Analysis
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DOI：
10.1016/j.jtho.2016.05.014
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发表时间：
2016-09-01
影响因子：
20.4
通讯作者：
Yoshino, Ichiro
中科院分区：
文献类型：
--
作者：
Hishida, Tomoyuki;Miyaoka, Etsuo;Yoshino, Ichiro
目的：本研究的目的是利用全国登记数据库，根据非小细胞肺癌患者的纵隔淋巴结清扫程度评估手术结局。在2004年日本肺癌登记研究的11,663名患者中，5392例通过肺叶切除术和系统性（SND）或肺叶特异性淋巴结清扫（LSD）完全切除的临床分期（c期）I或II期NSCLC患者被录取了排除术前接受治疗或有中叶肿瘤的患者。在LSD组中，上叶肿瘤不解剖下纵隔（隆突下）淋巴结，下叶肿瘤不解剖上级纵隔淋巴结。为了减少选择性偏倚，采用倾向评分的治疗加权法的逆概率implemented.Results：LSD和SND分别在1268例（23.5%）和4124例（76.5%）患者中进行。与SND组相比，LSD组包括更多的上叶和C-I期肿瘤和更少的病理N2疾病。在3.2%的SND组中发现了LSD区域外的扩展病理性N2疾病。LSD组5年总生存率为81.5%，SND组为75.9%。治疗权重调整的逆概率考克斯模型显示，LSD没有负面的预后影响，而是与有利的生存率（风险比= 0.68，95%置信区间：0.60-0.77）。结论：这项回顾性登记研究表明，LSD是一种替代SND的选择与C-阶段I或II NSCLC患者。未来的前瞻性研究是必要的，以确定是否LSD是适用的，并提供临床受益的一般人群的c期I或II期NSCLC患者。(C)2016年国际肺癌研究协会。爱思唯尔公司出版All rights reserved.
Objectives: The purpose of this study was to assess the surgical outcomes according to the extent of mediastinal lymph node dissection for patients with NSCLC by using a nationwide registry database.Methods: From among 11,663 patients in a Japanese lung cancer registry study for 2004, 5392 patients with clinical stage (c-stage) I or II NSCLC that was completely resected by lobectomy and either systematic (SND) or lobe-specific nodal dissection (LSD) were enrolled. Patients who received preoperative therapy or had middle lobe tumor were excluded. In the LSD group, inferior mediastinal (subcarinal) nodes were not dissected for upper lobe tumors, and superior mediastinal nodes were not dissected for lower lobe tumors. To reduce the selection bias, an inverse probability of treatment weighting method using a propensity score was implemented.Results: LSD and SND were performed in 1268 patients (23.5%) and 4124 patients (76.5%), respectively. The LSD group included more upper lobe and c-stage I tumors and less pathological N2 disease than the SND group. Extended pathological N2 disease outside LSD area was found in 3.2% of the SND group. The 5-year overall survival was 81.5% in the LSD group and 75.9% in the SND group. An inverse probability of treatment weighting-adjusted Cox model showed that LSD did not have a negative prognostic impact and instead was associated with favorable survival (hazard ratio = 0.68, 95% confidence interval: 0.60-0.77).Conclusions: This retrospective registry study suggested that LSD is an alternative to SND for selected patients with c-stage I or II NSCLC. Future prospective studies are warranted to determine whether LSD is applicable and provides clinical benefit for the general population of patients with c stage I or II NSCLC. (C) 2016 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.