Survival and Resected Lymph Node Number During Sublobar Resection for N0 Non-Small Cell Lung Cancer 2 cm or Less
Survival and Resected Lymph Node Number During Sublobar Resection for N0 Non-Small Cell Lung Cancer 2 cm or Less
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DOI：
10.1016/j.athoracsur.2018.12.024
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发表时间：
2019-06-01
影响因子：
4.6
通讯作者：
Jiang, Gening
中科院分区：
文献类型：
--
作者：
Ding, Hongdou;Wang, Haifeng;Jiang, Gening
背景资料。我们调查了直径在2厘米或以下的无淋巴结转移的非小细胞肺癌患者的生存率与叶下切除后检查的淋巴结数目的关系。监测、流行病学和最终结果数据库用于确定2004至2014年间确诊为2厘米或更小的非小细胞肺癌并接受楔形切除或节段切除的患者。根据手术方式(楔形切除、节段切除)、肿瘤大小(=10)对患者进行分层。分析淋巴结清扫数与总生存期(OS)和肺癌特异性生存期(LCS)的关系。共有2298名患者接受楔形切除，566名患者接受节段切除。对较大的肿瘤(1.43厘米对1.38厘米)进行了节段切除，并与更多的淋巴结切除相关(中位数：3对1)。倾向评分匹配后的多变量分析显示，淋巴结切除改善了接受楔形切除的患者的存活率，而不是改善了接受节段切除的患者的存活率。在楔形切除组中，与无1 cm或1 cm以下病变的患者相比，切除1~3个结节改善OS，4~9个结节改善OS和LCS。当切除10个或更多的结节时，没有观察到生存益处。对于1-2 cm的病变，随着检查的淋巴结数目的增加，生存期也随之增加。与切除10到16个结节的患者相比，切除超过16个结节的患者没有额外的生存益处。楔形切除应分别检查4~9和10~16个淋巴结是否有1 cm以下和1~2 cm的病变。在节段性切除中，对于小于或等于2厘米的病变，淋巴结切除并不能带来生存益处。(C)2019年，由胸外科医生学会主办
Background. We investigated the association between survival and the number of examined lymph nodes after sublobar resection for node-negative non-small cell lung cancer with size of 2 cm or less.Methods. The Surveillance, Epidemiology, and End Results database was used to identify patients diagnosed with non-small cell lung cancer 2 cm or less from 2004 to 2014 and underwent wedge resection or segmentectomy. Patients were stratified by the procedure (wedge resection, segmentectomy), the size of tumors (= 10). The relationship between the number of resected lymph nodes and overall survival (OS)/lung cancer-specific survival (LCSS) was analyzed.Results. A total of 2,298 patients with wedge resection and 566 patients with segmentectomy were identified. Segmentectomy was performed for bigger tumors (1.43 cm versus 1.38 cm) and was associated with more lymph nodes resected (median number: 3 versus 1). Multivariable analysis after propensity score matching revealed that lymph node resection improved survival for patients undergoing wedge resection while not for patients undergoing segmentectomy. In the wedge resection group, 1 to 3 nodes resected improved OS and 4 to 9 nodes improved OS and LCSS compared with patients without nodes evaluated for lesions 1 cm or less. No survival benefit was observed when 10 or more nodes were resected. For lesions 1 to 2 cm, incremental improvement in survival appeared with the increase of examined lymph node number. More than 16 nodes resected conferred no additional survival benefit compared with patients with 10 to 16 nodes resected.Conclusions. In wedge resection, 4 to 9 and 10 to 16 lymph nodes should be examined for lesions 1 cm or less and 1 to 2 cm, respectively. In segmentectomy, lymph node resection did not confer survival benefits for lesions 2 cm or less. (C) 2019 by The Society of Thoracic Surgeons