Tsutani Yasuhiro, Miyata Yoshihiro, Nakayama Haruhiko, Okumura Sakae, Adachi Shuji, Yoshimura Masahiro, Okada Morihito
Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan.
Eur J Cardiothorac Surg. 2014 Oct;46(4):637-42. doi: 10.1093/ejcts/ezt645. Epub 2014 Jan 28.
This study aimed to compare prognosis after segmentectomy and after lobectomy for radiologically determined solid-dominant clinical stage IA lung adenocarcinoma.
From a multicentre database of 610 consecutive patients with clinical stage IA lung adenocarcinoma who underwent complete resection after preoperative high-resolution computed tomography (HRCT) and F-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), 327 patients with a radiologically determined solid-dominant tumour (solid component on HRCT ≥50%) who underwent lobectomy (n = 286) or segmentectomy (n = 41) were included.
No significant difference existed in recurrence-free survival (RFS) between the lobectomy and segmentectomy groups (3-year RFS, 84.4 vs 84.8%, respectively; P = 0.69). There was no significant difference in recurrence pattern between these two groups (local, 5.6 vs 7.3%, P = 0.72; distant, 9.1 vs 4.9%, P = 0.55, respectively). Even in patients with pure solid tumours, no significant difference was observed in RFS between lobectomy and segmentectomy groups (3-year RFS, 76.8 vs 84.7%, respectively; P = 0.48), as well as in those with a mixed ground-glass opacity tumour (3-year RFS, 91.0 vs 85.0%, respectively; P = 0.60). Multivariate Cox analysis demonstrated that solid tumour size on HRCT (P = 0.048) and maximum standardized uptake value (SUVmax) on FDG-PET/CT (P < 0.001), not the surgical procedure (P = 0.40), were independent prognostic factors for RFS.
RFS depends on solid tumour size on HRCT and SUVmax on FDG-PET/CT, rather than on the surgical procedure, in patients with radiologically detected solid-dominant clinical stage IA lung adenocarcinoma. Patient prognosis is similar after lobectomy and after segmentectomy for solid-dominant tumour.
本研究旨在比较对于经影像学确定为实性为主的临床ⅠA期肺腺癌患者，肺段切除术与肺叶切除术后的预后情况。
从一个多中心数据库中选取610例临床ⅠA期肺腺癌患者，这些患者在术前均接受了高分辨率计算机断层扫描（HRCT）及F-18-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）检查，并接受了完整切除手术。其中327例经影像学确定为实性为主的肿瘤患者（HRCT上实性成分≥50%）纳入研究，这些患者接受了肺叶切除术（n = 286）或肺段切除术（n = 41）。
肺叶切除术组与肺段切除术组的无复发生存期（RFS）无显著差异（3年RFS分别为84.4%和84.8%；P = 0.69）。两组的复发模式也无显著差异（局部复发，分别为5.6%和7.3%，P = 0.72；远处复发，分别为9.1%和4.9%，P = 0.55）。即使是纯实性肿瘤患者，肺叶切除术组与肺段切除术组之间的RFS也无显著差异（3年RFS分别为76.8%和84.7%；P = 0.48），混合性磨玻璃影肿瘤患者亦是如此（3年RFS分别为91.0%和85.0%；P = 0.60）。多因素Cox分析表明，HRCT上的实性肿瘤大小（P = 0.048）及FDG-PET/CT上的最大标准化摄取值（SUVmax）（P < 0.001）是RFS的独立预后因素，而非手术方式（P = 0.40）。
对于经影像学检测为实性为主的临床ⅠA期肺腺癌患者，RFS取决于HRCT上的实性肿瘤大小及FDG-PET/CT上的SUVmax，而非手术方式。对于实性为主的肿瘤，肺叶切除术后与肺段切除术后患者的预后相似。
