Recurrence and Survival Outcomes After Anatomic Segmentectomy Versus Lobectomy for Clinical Stage I Non-Small-Cell Lung Cancer: A Propensity-Matched Analysis
Recurrence and Survival Outcomes After Anatomic Segmentectomy Versus Lobectomy for Clinical Stage I Non-Small-Cell Lung Cancer: A Propensity-Matched Analysis
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DOI：
10.1200/jco.2013.50.8762
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发表时间：
2014-08-10
影响因子：
45.3
通讯作者：
Schuchert, Matthew J.
中科院分区：
文献类型：
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作者：
Landreneau, Rodney J.;Normolle, Daniel P.;Schuchert, Matthew J.
许多外科医生认为Persealthough解剖分割切除术已被认为是一种妥协的手术，最近的回顾性，单机构系列已证明肿瘤复发和患者存活率近似于小叶切除术所获得的肿瘤。这项研究的主要目的是使用倾向评分匹配来比较这些解剖学切除方法的非小细胞肺癌。患者和方法回顾性数据集，包括392例分段切除术患者和800例肺叶切除术患者使用倾向评分与算法相匹配的分割切除术和肺切除术队列（n = 312名患者）术前患者变量的混杂作用。主要结果变量包括免于复发和整体生存。通过COX回归分析和Kaplan-Meier估计来评估影响生存的因素。分割切除术组的术中术中的死亡率为1.2％，在叶切除术组中为2.5％（p = .38）。在平均随访为5。4年，比较分段切除术与叶切除术，局部区域中没有差异（分别为5.5％V 5.1％； p = 1.00），远处（分别为14.8％v 11.6％； p = .29）或总体复发率（分别为20.2％V 16.7％； p = .30）。此外，当比较分段切除术与叶切除术时，没有复发的5年自由度（分别为70％V 71％； p = .467）或5年生存期（分别为54％V 60％； p = p = = .467）； .258）。没有发现分段切除术是复发的独立预测指标（危险比，1.11; 95％CI，0.87至1.40）或总生存率（危险比，1.17; 95％CI，0.89至1.52）。叶切除术与避免复发和整体生存的自由相关，但差异在统计学上并不显着。这些结果将需要通过前瞻性，随机试验进行进一步验证（例如，癌症和白血病B 140503试验）。 （c）2014年美国临床肿瘤学会
PurposeAlthough anatomic segmentectomy has been considered a compromised procedure by many surgeons, recent retrospective, single-institution series have demonstrated tumor recurrence and patient survival rates that approximate those achieved by lobectomy. The primary objective of this study was to use propensity score matching to compare outcomes after these anatomic resection approaches for stage I non-small-cell lung cancer.Patients and MethodsA retrospective data set including 392 segmentectomy patients and 800 lobectomy patients was used to identify matched segmentectomy and lobectomy cohorts (n = 312 patients per group) using a propensity score matching algorithm that accounted for confounding effects of preoperative patient variables. Primary outcome variables included freedom from recurrence and overall survival. Factors affecting survival were assessed by Cox regression analysis and Kaplan-Meier estimates.ResultsPerioperative mortality was 1.2% in the segmentectomy group and 2.5% in the lobectomy group (P = .38). At a mean follow-up of 5.4 years, comparing segmentectomy with lobectomy, no differences were noted in locoregional (5.5% v 5.1%, respectively; P = 1.00), distant (14.8% v 11.6%, respectively; P = .29), or overall recurrence rates (20.2% v 16.7%, respectively; P = .30). Furthermore, when comparing segmentectomy with lobectomy, no significant differences were noted in 5-year freedom from recurrence (70% v 71%, respectively; P = .467) or 5-year survival (54% v 60%, respectively; P = .258). Segmentectomy was not found to be an independent predictor of recurrence (hazard ratio, 1.11; 95% CI, 0.87 to 1.40) or overall survival (hazard ratio, 1.17; 95% CI, 0.89 to 1.52).ConclusionIn this large propensity-matched comparison, lobectomy was associated with modestly increased freedom from recurrence and overall survival, but the differences were not statistically significant. These results will need further validation by prospective, randomized trials (eg, Cancer and Leukemia Group B 140503 trial). (C) 2014 by American Society of Clinical Oncology