Oncologic Outcomes of Segmentectomy Versus Lobectomy for Clinical T1a N0 M0 Non-Small Cell Lung Cancer
Oncologic Outcomes of Segmentectomy Versus Lobectomy for Clinical T1a N0 M0 Non-Small Cell Lung Cancer
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DOI：
10.1016/j.athoracsur.2015.08.063
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发表时间：
2016-02-01
影响因子：
4.6
通讯作者：
Kuriyama, Keiko
中科院分区：
文献类型：
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作者：
Kodama, Ken;Higashiyama, Masahiko;Kuriyama, Keiko
背景。我们回顾性比较了临床（c-） T1a N0 M0非小细胞肺癌（NSCLC）在薄层计算机断层扫描上显示为部分实性磨玻璃结节或纯实性结节的患者，在进行节段切除术和肺叶切除术后的肿瘤预后。从1997年到2010年，312例c-T1a N0 M0 NSCLC患者被确定需要手术入路，分类为节段切除术或肺叶切除术。采用logistic回归分析收集术前可用资料，并进行倾向匹配。采用Cox比例风险回归分析和Kaplan-Meier估计评估影响局部-区域复发的因素。80例行节段切除术患者的5年和10年总生存率分别为97.5%和83.5%，而232例行肺叶切除术患者的5年和10年总生存率分别为87.75%和75.0% （p = 0.019）。80例肺段切除术中有3例（3.8%）出现局部-区域复发，232例肺叶切除术中有15例（6.5%）出现局部-区域复发。节段切除术与肺叶切除术的局部-区域无复发生存率差异无统计学意义（p = 0.304）。在69对倾向评分匹配的患者中，两组患者的总生存率（p = 0.442）或局部-区域无复发生存率（p = 0.717）无显著差异。采用Cox比例风险回归模型进行多因素分析，发现淋巴浸润是预测局部-区域复发的唯一独立因素（相对危险度为10.764；95%可信区间为2.98 ~ 57.68）。我们的研究结果表明，在c-T1a N0 M0 NSCLC患者队列中，节段切除术与肺叶切除术的肿瘤学结果相似。这些结果将通过大规模、前瞻性、随机试验来验证。(C) 2016年由胸外科学会发布
Background. We retrospectively compared the oncologic outcome after segmentectomy versus lobectomy in patients with clinical (c-) T1a N0 M0 non-small cell lung cancer (NSCLC) detected as a part-solid ground-glass nodule or purely solid nodule on thin-section computed tomography.Methods. From 1997 to 2010, 312 patients with c-T1a N0 M0 NSCLC were determined to require a surgical approach categorized as segmentectomy or lobectomy. Preoperatively available data were collected using logistic regression analysis, and propensity matching was performed. Factors affecting local-regional recurrence were assessed by Cox proportional hazards regression analysis and Kaplan-Meier estimates.Results. The 5-year and 10-year overall survival rates for the 80 patients who underwent segmentectomy were 97.5% and 83.5%, respectively, compared with 87.75% and 75.0%, respectively, for the 232 patients who underwent lobectomy (p = 0.019). Local-regional recurrence as the first relapse site was found in 3 the 80 segmentectomies (3.8%) of and in 15 of the 232 lobectomies (6.5%). The difference in local-regional recurrence-free survival in patients undergoing segmentectomy compared with lobectomy was not significant (p = 0.304). In 69 propensity score-matched pairs, there was no significant difference in the overall survival (p = 0.442) or local-regional recurrence-free survival (p = 0.717) between the two groups. Multivariate analysis using the Cox proportional hazards regression model identified lymphatic invasion as the only independent factor predicting local-regional recurrence (relative risk, 10.764; 95% confidence interval, 2.98 to 57.68).Conclusions. Our results suggest that the oncologic outcome of segmentectomy vs lobectomy is similar in this cohort of c-T1a N0 M0 NSCLC patients. These results will be validated by large-scale, prospective, randomized trials. (C) 2016 by The Society of Thoracic Surgeons