Lobe-Specific Lymph Node Dissection as a Standard Procedure in Surgery for Non-Small Cell Lung Cancer: A Propensity Score Matching Study
Lobe-Specific Lymph Node Dissection as a Standard Procedure in Surgery for Non-Small Cell Lung Cancer: A Propensity Score Matching Study
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DOI：
10.1016/j.jtho.2016.08.127
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发表时间：
2017-01-01
影响因子：
20.4
通讯作者：
Masuda, Munetaka
中科院分区：
文献类型：
--
作者：
Adachi, Hiroyuki;Sakamaki, Kentaro;Masuda, Munetaka
简介：系统性淋巴结清扫术（SND）是非小细胞肺癌手术治疗的标准程序，但这种方法对生存和淋巴结分期的价值仍不确定。在本研究中，我们采用倾向评分匹配法评估了肺叶特异性淋巴结清扫术（L-SND）在NSCLC手术中的潜力。方法：2005年至2007年，我们的10家附属医院对565例cT1a-2b NO-1 MO NSCLC患者进行了肺叶切除术和淋巴结清扫术。根据淋巴结切除的数量和范围的病理数据，将患者分为接受淋巴结取样、L-SND 和系统性解剖 SND 的组。共有77例病理数据不足的患者被排除在研究之外。 结果：总体而言，各组之间的生存率没有显着差异（p = 0.552），但SND组中pN2的检出率（13.1%）显着高于淋巴结取样组（3.3%）和L-SND组（9.0%）（p = 0.010）。然而，考虑到每组患者特征中存在许多混杂因素，使用倾向评分匹配方法对 L-SND 和 SND 组的结果进行了重新评估。匹配后，两组的 5 年总生存率（L-SND 为 73.5%，SND 为 75.3%，p = 0.977）和 pN2 检测（两组均为 8.2%，p = 0.779）没有显着差异。 结论：这些结果表明，肺叶特异性淋巴结清扫有可能成为 NSCLC 手术治疗的标准程序。 (C) 2016 年国际肺癌研究协会。由爱思唯尔公司出版。保留所有权利。
Introduction: Systematic lymph node dissection (SND) is the standard procedure in surgical treatment for NSCLC, but the value of this approach for survival and nodal staging is still uncertain. In this study, we evaluated the potential of lobe-specific lymph node dissection (L-SND) in surgery for NSCLC by using a propensity score matching method.Methods: From 2005 to 2007, 565 patients with cT1a-2b NO-1 MO NSCLC underwent lobectomy with lymph node dissection at our 10 affiliated hospitals. Patients were classified into groups that underwent nodal sampling, L-SND, and systematic dissection SND on the basis of pathological data for the number and extent of nodal resection. A total of 77 patients with insufficient pathological data were excluded from the study.Results: Overall, survival did not differ significantly among the groups (p = 0.552), but the rate of detection of pN2 in the SND group (13.1%) was significantly higher than in the nodal sampling (3.3%) and L-SND (9.0%) groups (p = 0.010). However, given the many confounding factors in the patient characteristics in each group, outcomes were reevaluated using a propensity score matching method for the L-SND and SND groups. After matching, the two groups had no significant differences in 5-year overall survival (73.5% for L-SND versus 75.3% for SND, p = 0.977) and pN2 detection (8.2% in both groups, p = 0.779).Conclusions: These results suggest that lobe-specific lymph node dissection has the potential to be a standard procedure in surgical treatment for NSCLC. (C) 2016 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.