Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Ann Thorac Surg. 2012 Aug;94(2):354-60; discussion 360-1. doi: 10.1016/j.athoracsur.2011.12.092. Epub 2012 Mar 17.
Many patients with resectable non-small cell lung cancer (NSCLC) are unfit for lobectomy owing to comorbidity. Surgical outcomes are biased by preoperative selection factors and upstaging that occurs during surgery. This study compares outcomes between sublobar pulmonary resection and traditional external beam radiation therapy.
This cohort study utilizes Surveillance, Epidemiology, and End Results-Medicare data (1998 to 2005). Patients with stage IA NSCLC treated with either radiotherapy or sublobar resection were compared. The bias of clinical staging in the radiation group versus pathologic staging in the surgical group was addressed by including only sublobar resections without lymph node sampling. Medicare claims data were used to calculate a modified Charlson comorbidity score for each patient.
In all, 878 patients received radiotherapy and 657 underwent sublobar resection without lymph node sampling. Radiation patients were older (77.0 versus 75.5 years, p<0.0001) and had larger tumors (22.8 versus 17.9 mm, p<0.0001). There was no difference in comorbidity scores between groups (p=0.21). Three-year overall survival favored sublobar resection (56% versus 35%; p<0.0001). Predictors of earlier death were radiation, age, comorbidity score, tumor size, male sex, and prior malignancy (all p<0.05). Propensity analysis matched 319 radiation patients and 319 sublobar resection patients. In this subgroup, 3-year overall survival favored sublobar resection (52% versus 41%; p<0.001).
Sublobar resection without lymph node sampling appears to be superior to radiotherapy for clinical stage IA NSCLC. For patients with prohibitive risk for lobectomy, sublobar resection may be preferable to radiotherapy. Radiotherapy results in current and future patients are likely to be better.
许多可切除的非小细胞肺癌（NSCLC）患者因合并症而不适合进行肺叶切除术。手术前的选择因素和术中的分期升级会影响手术结果。本研究比较了亚肺叶切除术和传统外照射放疗的治疗效果。
本队列研究使用监测、流行病学和最终结果-医疗保险数据（1998 年至 2005 年）。比较了接受放疗或亚肺叶切除术治疗的 IA 期 NSCLC 患者。通过仅纳入未行淋巴结采样的亚肺叶切除术，解决了放疗组临床分期与手术组病理分期之间的偏倚问题。医疗保险索赔数据用于计算每位患者的改良 Charlson 合并症评分。
共有 878 例患者接受放疗，657 例患者行亚肺叶切除术且未行淋巴结采样。放疗患者年龄更大（77.0 岁比 75.5 岁，p<0.0001），肿瘤更大（22.8 毫米比 17.9 毫米，p<0.0001）。两组患者的合并症评分无差异（p=0.21）。亚肺叶切除术组的 3 年总生存率更高（56%比 35%；p<0.0001）。死亡的预测因素包括放疗、年龄、合并症评分、肿瘤大小、男性和既往恶性肿瘤（均 p<0.05）。倾向评分匹配了 319 例放疗患者和 319 例亚肺叶切除术患者。在该亚组中，亚肺叶切除术组的 3 年总生存率更高（52%比 41%；p<0.001）。
对于临床分期为 IA 期的 NSCLC 患者，不进行淋巴结采样的亚肺叶切除术似乎优于放疗。对于不适合进行肺叶切除术的患者，亚肺叶切除术可能优于放疗。未来的放疗效果可能会更好。
