Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
J Surg Res. 2013 Jul;183(1):27-32. doi: 10.1016/j.jss.2012.11.052. Epub 2012 Dec 20.
Since the randomized, controlled study that favored lobectomy for resection of stage I non-small cell lung cancers (NSCLCs) by the Lung Cancer Study Group, there have been improvements in staging. The liberal use of computed tomography also may have altered the types of early lung cancer diagnosed. Studies published since then have drawn contradictory conclusions on the benefit of lobectomy over sublobar resections for early-stage NSCLC. We examined the Surveillance Epidemiology End Results database to test our hypothesis that the relationship between extent of resection and outcome has changed since the Lung Cancer Study Group study was published.
We examined stage I NSCLCs ≤ 2 cm in size over three periods: 1988-1998 (Early), 1999-2004 (Intermediate), and 2005-2008 (Late). For each period, we assessed overall and disease-specific survivals and their associations with the extents of resection, by univariate and multivariate analyses. Sublobar resections in the Early group could not be categorized into segmentectomies and wedge resections because these were not coded separately.
The proportion of NSCLCs ≤ 2 cm increased from 0.98% in 1988 to 2.2% in 2008. Multivariate analyses showed that sublobar resection was inferior to lobectomy in the Early period (hazard ratio [HR], 1.41; 95% confidence interval [CI], 1.21-1.65). This effect decreased in the Intermediate period, in which segmentectomies but not wedge resections were equivalent to lobectomies (wedge versus lobectomy HR, 1.19; 95% CI, 1.01-1.41; segmentectomy versus lobectomy HR, 1.04; 95% CI, 0.8-1.36). The difference disappeared in the Late period, when both wedge resections and segmentectomies were equivalent to lobectomy (wedge versus lobectomy HR, 1.09; 95% CI, 0.79-1.5; segmentectomy versus lobectomy HR, 0.83; 95% CI, 0.47-1.45). Trends for both overall survival and disease-specific survival were identical.
The survival benefit of lobectomy over sublobar resection decreased over the past 2 decades with no discernible difference in the most contemporary cases. These results support reevaluation of lobectomy as the standard of care for small (≤ 2-cm) NSCLCs.
自从肺癌研究组进行的有利于肺叶切除术治疗 I 期非小细胞肺癌（NSCLC）的随机对照研究以来，分期方法得到了改进。计算机断层扫描的广泛应用也可能改变了早期肺癌的诊断类型。此后发表的研究对早期 NSCLC 肺叶切除术与亚肺叶切除术的益处得出了相互矛盾的结论。我们检查了监测、流行病学和最终结果数据库，以检验我们的假设，即自肺癌研究组研究发表以来，切除术范围与结果之间的关系发生了变化。
我们检查了三个时期大小≤2cm 的 I 期 NSCLC：1988-1998 年（早期）、1999-2004 年（中期）和 2005-2008 年（晚期）。对于每个时期，我们通过单变量和多变量分析评估了总体生存率和疾病特异性生存率及其与切除术范围的关系。由于早期组的亚肺叶切除术不能分为节段切除术和楔形切除术，因为这些没有单独编码。
大小≤2cm 的 NSCLC 的比例从 1988 年的 0.98%增加到 2008 年的 2.2%。多变量分析显示，在早期阶段，亚肺叶切除术不如肺叶切除术（风险比[HR]，1.41；95%置信区间[CI]，1.21-1.65）。这种影响在中期阶段减弱，此时节段切除术但不是楔形切除术与肺叶切除术等效（楔形切除术与肺叶切除术 HR，1.19；95%CI，1.01-1.41；节段切除术与肺叶切除术 HR，1.04；95%CI，0.8-1.36）。在晚期阶段，楔形切除术和节段切除术与肺叶切除术等效时，这种差异消失（楔形切除术与肺叶切除术 HR，1.09；95%CI，0.79-1.5；节段切除术与肺叶切除术 HR，0.83；95%CI，0.47-1.45）。总体生存率和疾病特异性生存率的趋势完全相同。
在过去的 20 年里，肺叶切除术优于亚肺叶切除术的生存获益减少，在最近的病例中没有明显差异。这些结果支持重新评估肺叶切除术作为治疗小（≤2cm）NSCLC 的标准治疗方法。
