Lobectomy Versus Sublobar Resection for Small (2 cm or Less) Non-Small Cell Lung Cancers
Lobectomy Versus Sublobar Resection for Small (2 cm or Less) Non-Small Cell Lung Cancers
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DOI：
10.1016/j.athoracsur.2011.06.099
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发表时间：
2011-11-01
影响因子：
4.6
通讯作者：
Swanson, Scott J.
中科院分区：
文献类型：
--
作者：
Wolf, Andrea S.;Richards, William G.;Swanson, Scott J.
背景资料。我们评估了一组接受小细胞(2厘米或以下)非小细胞肺癌(NSCLC)切除的患者，以确定切除范围(叶或叶下切除)与局部复发或存活率之间是否存在关联。我们回顾了2000-2005年间在我们机构连续接受小非小细胞肺癌切除术的468名患者。我们排除了接受新辅助治疗、活动性非皮肤恶性肿瘤、单纯细支气管肺泡癌、淋巴转移(n=53)或确诊时远处转移或多中心性癌症的患者。检索了截至2010年6月15日的临床病理数据、复发情况和生命状态。评估手术后的总体生存率和无复发生存率。238例原发孤立性小非小细胞肺癌患者行手术切除。肺叶切除术(n=84)与总生存期(p=0.0027)和无复发生存期(p=0.0496)相关。接受叶下叶切除术的患者年龄较大(p<；0.0001)，肺功能较差(p<；0.0014)。虽然叶下切除术的局部复发率有增加的趋势(16%比8%，p=0.1117)，但远处复发率没有差异。此外，对淋巴结进行叶下切除术后，局部复发率、总生存率和无复发生存率分布与肺叶切除术相似。对于心肺功能受限的老年患者，叶下切除术是合理的。然而，对于健康的患者，肺叶切除仍然是标准的治疗方法，叶下切除加淋巴结采样是一种可供考虑的选择。这些发现支持继续努力进行叶切除与叶下切除的随机试验，如CALGB 140503。(Ann Thorac Surg 2011；92：1819-25)(C)2011年，胸外科学会
Background. We evaluated a cohort of patients who underwent resection for small (2 cm or less) non-small cell lung cancer (NSCLC) to determine if there is an association between extent of resection (lobar versus sublobar resection) and local recurrence or survival.Methods. We reviewed 468 consecutive patients who underwent resection for small NSCLC at our institution between 2000 and 2005. We excluded patients who had neoadjuvant therapy, active noncutaneous malignancies, pure bronchioalveolar carcinoma, lymph node (n = 53) or distant metastases at diagnosis, or multicentric cancers. Clinicopathologic data, recurrence, and vital status as of June 15, 2010, were retrieved. Overall and recurrence-free survival from surgery rates were assessed.Results. Two hundred thirty-eight patients underwent resection for primary solitary small NSCLC. Lobectomy (n = 84) was associated with longer overall (p = 0.0027) and recurrence-free (p = 0.0496) survival. Patients who underwent sublobar resection were older (p < 0.0001) and had worse pulmonary function (p < 0.0014). While there was a trend toward increased rate of local recurrence for sublobar resection (16% versus 8%, p = 0.1117), there was no difference in distant recurrence. Moreover, when lymph nodes were sampled with sublobar resection, local recurrence rate and overall and recurrence-free survival distributions were similar to those for lobectomy.Conclusions. Sublobar resection is reasonable in older patients with limited cardiopulmonary function. For healthy patients, however, lobectomy remains the standard therapy, with sublobar resection with lymph node sampling representing an alternative to consider. These findings support continued effort to conduct a randomized trial of lobar versus sublobar resection, such as CALGB 140503. (Ann Thorac Surg 2011; 92: 1819 -25) (C) 2011 by The Society of Thoracic Surgeons