Griffin John P, Eastridge Charles E, Tolley Elizabeth A, Pate James W
Division of Pulmonary and Critical Care Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
J Thorac Oncol. 2006 Nov;1(9):960-4.
Possibility of curative resection by lobectomy for non-small cell lung cancer is often denied patients with compromised pulmonary reserve. Analysis of survival of such patients treated by wedge resection was compared with that of patients treated by standard resection, with both groups followed for 10 years.
A prospective 5-year cohort study.
From 1988 to 1992, an observational cohort of 127 consecutive resected patients at Memphis VA Medical Center was divided into those receiving lobectomy in 81 cases and pneumonectomy in 15 cases (group I) versus 31 patients with compromised pulmonary reserve (group II), who had complete tumor excision by wedge resection. Preoperative clinical staging was corrected to surgical-pathological staging after demonstration of its superiority. Survival estimates were obtained by Kaplan-Meier method with curves compared by log rank tests, with all-cause mortality calculated from date of surgery.
Extent of disease in group I was 58% stage I, 19% stage II, and 23% stage III. In group II, extent of disease was 84% stage I, 3% stage II, and 14% stage III. Group I median survival was 26 months with 30% 5-year survival; for group II, median survival was 30 months and 32%. Kaplan-Meier survival plots showed similar curves in groups I and II. Realizing less extent of disease in group II, another Kaplan-Meier plot restricted to stage I and II patients showed overlapping survival curves for groups I and II.
Survival during 10-year observation was similar for patients with pulmonary insufficiency treated by wedge resection to that of patients receiving standard resection in this single-institution consecutive cohort.
对于肺储备功能受损的非小细胞肺癌患者，常认为无法通过肺叶切除术进行根治性切除。对这类接受楔形切除术患者的生存情况进行分析，并与接受标准切除术患者的生存情况作比较，两组均随访10年。
一项前瞻性5年队列研究。
1988年至1992年，孟菲斯退伍军人事务医疗中心连续127例接受手术切除的患者组成观察队列，分为81例行肺叶切除术和15例行全肺切除术的患者（第一组），以及31例肺储备功能受损、通过楔形切除术完整切除肿瘤的患者（第二组）。术前临床分期经证实其优越性后校正为手术病理分期。采用Kaplan-Meier法获得生存估计值，通过对数秩检验比较曲线，从手术日期计算全因死亡率。
第一组疾病分期为58%为I期，19%为II期，23%为III期。第二组疾病分期为84%为I期，3%为II期，14%为III期。第一组中位生存期为26个月，5年生存率为30%；第二组中位生存期为30个月，5年生存率为32%。Kaplan-Meier生存曲线显示第一组和第二组曲线相似。考虑到第二组疾病范围较小，另一项限于I期和II期患者的Kaplan-Meier曲线显示第一组和第二组生存曲线重叠。
在这个单机构连续队列中，接受楔形切除术的肺功能不全患者与接受标准切除术的患者在10年观察期内的生存率相似。
