Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
Chest. 2014 Jul;146(1):175-181. doi: 10.1378/chest.13-2506.
The 2011 International Association for the Study of Lung Cancer (IASLC)/American Thoracic Society (ATS)/European Respiratory Society (ERS) classification of pulmonary adenocarcinomas introduces adenocarcinoma in situ and minimally invasive carcinoma and categorizes adenocarcinoma with more extensive invasion by the predominant subtype. Data have shown that wedge or segmentectomy (W/S) may be appropriate for in situ and minimally invasive adenocarcinoma, but whether sublobar resection is appropriate for tumors with more extensive invasion is unclear. The aim of this pilot study is to evaluate whether there are any trends regarding the impact of invasion and subtypes of carcinoma regarding survival in lobectomy vs W/S procedures using a comprehensive histologic evaluation.
Eighty-five surgical specimens (59 lobectomies, 26 W/Ss) were reviewed. Histologic type, size, pleural, lymphovascular invasion, and necrosis were recorded. Adenocarcinomas were classified by 2011 IASLC/ATS/ERS guidelines with each histologic pattern recorded as a percentage of the total tumor. Statistical analysis was performed using SAS, version 9.2. Proportional hazards regression analysis was used to evaluate survival according to resection type (lobectomy or W/S) adjusting for tumor size and the predominant histology.
Multivariate analysis did not show a statistically significant difference in survival between lobectomy and W/S specimens adjusting for tumor size, regardless of histologic subtype or other negative predictors of prognosis (P = .7704).
Our findings corroborate the prognostic significance of the 2011 adenocarcinoma subtyping classification and additionally suggest that lobectomy does not offer an overall survival advantage over W/S regardless of histologic subtype. Therefore, this finding suggests that limited resection may be appropriate for small size tumors, particularly those ≤ 2 cm with invasive histology.
2011 年国际肺癌研究协会（IASLC）/美国胸科学会（ATS）/欧洲呼吸学会（ERS）肺腺癌分类引入了原位腺癌和微浸润癌，并根据主要亚型对侵袭性更强的腺癌进行分类。数据表明，楔形切除术或节段切除术（W/S）可能适用于原位和微浸润性腺癌，但对于侵袭性更强的肿瘤，亚肺叶切除术是否合适尚不清楚。本研究旨在通过全面的组织学评估，评估在肺叶切除术与 W/S 手术中，侵袭程度和癌亚型对生存的影响是否存在任何趋势。
回顾了 85 例手术标本（59 例肺叶切除术，26 例 W/S）。记录了组织学类型、大小、胸膜、血管淋巴管侵犯和坏死情况。腺癌按 2011 年 IASLC/ATS/ERS 指南进行分类，每种组织学模式均以占总肿瘤的百分比记录。使用 SAS 版本 9.2 进行统计分析。采用比例风险回归分析，根据切除类型（肺叶切除术或 W/S），在调整肿瘤大小和主要组织学的基础上，评估生存情况。
多变量分析显示，在调整肿瘤大小后，W/S 与肺叶切除术标本之间的生存差异无统计学意义，无论组织学亚型或其他预后不良的预测因素如何（P =.7704）。
我们的研究结果证实了 2011 年腺癌亚型分类的预后意义，并且还表明，无论组织学亚型如何，肺叶切除术并不比 W/S 提供总体生存优势。因此，这一发现表明，对于小肿瘤，特别是侵袭性组织学的≤2cm 大小的肿瘤，有限的切除术可能是合适的。
