肺段切除术与肺叶切除术治疗ⅠA 期肺腺癌的比较
Segmentectomy versus lobectomy for clinical stage IA lung adenocarcinoma.
机构信息
1 Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan ; 2 Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan ; 3 Department of Thoracic Surgery, Cancer Institute Hospital, Tokyo, Japan ; 4 Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan.
出版信息
Ann Cardiothorac Surg. 2014 Mar;3(2):153-9. doi: 10.3978/j.issn.2225-319X.2014.02.10.
BACKGROUND
Despite the increasing prevalence of the early discovery of small-sized non-small cell lung cancers (NSCLCs), particularly adenocarcinoma, sublobar resection has not yet gained acceptance for patients who can tolerate lobectomy.
METHODS
We compared the outcomes of segmentectomy (n=155) and lobectomy (n=479) in 634 consecutive patients with clinical stage IA lung adenocarcinoma and in propensity score-matched pairs. Those who had undergone wedge resection were excluded.
RESULTS
The 30-day postoperative mortality rate in this population was zero. Patients with large or right-sided tumors, high maximum standardized uptake value (SUVmax), pathologically invasive tumors (with lymphatic, vascular, or pleural invasion), and lymph node metastasis underwent lobectomy significantly more often. Three-year recurrence-free survival (RFS) was significantly higher after segmentectomy compared to lobectomy (92.7% vs. 86.9%, P=0.0394), whereas three-year overall survival (OS) did not significantly differ (95.7% vs. 94.1%, P=0.162). Multivariate analyses of RFS and OS revealed age and SUVmax as significant independent prognostic factors, whereas gender, tumor size and procedure (segmentectomy vs. lobectomy) were not. In 100 propensity score-matched pairs with variables adjusted for age, gender, tumor size, SUVmax, tumor location, the three-year RFS (90.2% vs. 91.5%) and OS (94.8% vs. 93.3%) after segmentectomy and lobectomy respectively were comparable.
CONCLUSIONS
Segmentectomy with reference to SUVmax should be considered as an alternative for clinical stage IA adenocarcinoma, even for low-risk patients.
背景
尽管越来越多的小尺寸非小细胞肺癌（NSCLC），特别是腺癌，能够早期发现，但对于能够耐受肺叶切除术的患者来说，亚肺叶切除术尚未被接受。
方法
我们比较了 634 例临床 IA 期肺腺癌患者的亚肺叶切除术（n=155）和肺叶切除术（n=479）的结果，并进行了倾向评分匹配对。排除了接受楔形切除术的患者。
结果
该人群的 30 天术后死亡率为零。肿瘤较大或位于右侧、最大标准化摄取值（SUVmax）较高、病理侵袭性肿瘤（有淋巴、血管或胸膜侵犯）和淋巴结转移的患者更常接受肺叶切除术。与肺叶切除术相比，亚肺叶切除术的 3 年无复发生存率（RFS）显著更高（92.7% vs. 86.9%，P=0.0394），而 3 年总生存率（OS）无显著差异（95.7% vs. 94.1%，P=0.162）。RFS 和 OS 的多变量分析显示年龄和 SUVmax 是显著的独立预后因素，而性别、肿瘤大小和手术方式（亚肺叶切除术 vs. 肺叶切除术）不是。在 100 对经变量调整后的倾向评分匹配对中，包括年龄、性别、肿瘤大小、SUVmax、肿瘤位置，亚肺叶切除术和肺叶切除术的 3 年 RFS（90.2% vs. 91.5%）和 OS（94.8% vs. 93.3%）相当。
结论
对于临床 IA 期腺癌，尤其是低危患者，应考虑根据 SUVmax 行亚肺叶切除术。
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