Koike Terumoto, Kitahara Akihiko, Sato Seijiro, Hashimoto Takehisa, Aoki Tadashi, Koike Teruaki, Yoshiya Katsuo, Toyabe Shin-Ichi, Tsuchida Masanori
Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Division of Chest Surgery, Niigata Cancer Center Hospital, Niigata, Japan.
Ann Thorac Surg. 2016 Apr;101(4):1354-60. doi: 10.1016/j.athoracsur.2015.10.048. Epub 2016 Jan 12.
The indication for limited resection of radiologically pure solid non-small cell lung cancer (NSCLC) is controversial owing to its invasive pathologic characteristics. This study was performed to compare the outcomes after lobectomy and segmentectomy in these NSCLC patients.
We retrospectively reviewed 251 patients with radiologically pure solid cT1a N0 M0 NSCLC who underwent lobectomy or segmentectomy, and the preoperative characteristics of the patients treated with the two operative techniques were matched using propensity score methods. Overall survival (OS) and disease-free survival (DFS) curves were compared using the log rank test, and differences in survival were also evaluated by the McNemar test. The preoperative factors and surgical procedure were analyzed with the multivariate Cox proportional hazards regression model to identify independent predictors of poor OS and DFS.
In the propensity score matched lobectomy and segmentectomy groups (87 patients per group), the 5-year and 10-year OS rates were 85% versus 84% and 66% versus 63%, respectively; and the 5-year and 10-year DFS rates were 80% versus 77% and 64% versus 58%, respectively. There were no significant differences between the two groups in OS or DFS by the log rank test, and also no significant differences in 3-year, 5-year, or 7-year OS or DFS by the McNemar test. Although age, smoking status, pulmonary function, and carcinoembryonic antigen were identified as significant predictors of both OS and DFS, the surgical procedure was not identified.
Similar oncologic outcomes after lobectomy and segmentectomy were indicated among patients with radiologically pure solid small-sized NSCLC.
由于其侵袭性病理特征，对于影像学上表现为纯实性的非小细胞肺癌（NSCLC）进行有限切除的指征存在争议。本研究旨在比较这些NSCLC患者肺叶切除术和肺段切除术后的结局。
我们回顾性分析了251例接受肺叶切除术或肺段切除术的影像学表现为纯实性cT1a N0 M0 NSCLC患者，并使用倾向评分法对接受两种手术技术治疗的患者术前特征进行匹配。采用对数秩检验比较总生存（OS）和无病生存（DFS）曲线，并通过McNemar检验评估生存差异。使用多变量Cox比例风险回归模型分析术前因素和手术方式，以确定OS和DFS不良的独立预测因素。
在倾向评分匹配的肺叶切除术组和肺段切除术组（每组87例患者）中，5年和10年OS率分别为85%对84%和66%对63%；5年和10年DFS率分别为80%对77%和64%对58%。对数秩检验显示两组在OS或DFS方面无显著差异，McNemar检验显示在3年、5年或7年OS或DFS方面也无显著差异。尽管年龄、吸烟状态、肺功能和癌胚抗原被确定为OS和DFS的显著预测因素，但手术方式未被确定。
影像学表现为纯实性的小尺寸NSCLC患者中，肺叶切除术和肺段切除术后的肿瘤学结局相似。
