老年早期肺癌患者肺段切除术或肺叶切除术后的生存率
Survival following segmentectomy or lobectomy in elderly patients with early-stage lung cancer.
作者信息
Zhang Yang, Yuan Chongze, Zhang Yawei, Sun Yihua, Chen Haiquan
机构信息
Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
出版信息
Oncotarget. 2016 Apr 5;7(14):19081-6. doi: 10.18632/oncotarget.7704.
Abstract
PURPOSE
To determine the survival following segmentectomy versus lobectomy in elderly patients with early-stage non-small cell lung cancer (NSCLC).
METHODS
We identified 12324 elderly (≥ 70 years) patients with stage I ≤ 3 cm NSCLC in the Surveillance, Epidemiology and End Results (SEER) database. Propensity score methods were used to balance baseline characteristics of patients undergoing segmentectomy or lobectomy. Overall survival (OS) and lung cancer-specific survival (LCSS) of patients treated with segmentectomy versus lobectomy were compared in Cox regression models after adjusting, stratifying or matching patients based on propensity scores.
RESULTS
Cox models adjusting, stratifying or matching propensity scores all showed that patients treated with segmentectomy had significantly worse OS and LCSS compared to lobectomy. Subgroup analysis of patients with tumors ≤ 2cm, aged ≥ 75 years, or had ≥ 7 lymph nodes examined also revealed survival advantage associated with lobectomy.
CONCLUSION
Elder age alone could not justify the application of segmentectomy in early-stage lung cancer. Prospective randomized trials are warranted to validate our results.
摘要
目的
确定老年早期非小细胞肺癌（NSCLC）患者行肺段切除术与肺叶切除术的生存率。
方法
我们在监测、流行病学和最终结果（SEER）数据库中识别出12324例年龄≥70岁、I期且肿瘤≤3 cm的NSCLC患者。采用倾向评分方法平衡接受肺段切除术或肺叶切除术患者的基线特征。在根据倾向评分对患者进行调整、分层或匹配后，在Cox回归模型中比较接受肺段切除术与肺叶切除术患者的总生存期（OS）和肺癌特异性生存期（LCSS）。
结果
调整、分层或匹配倾向评分的Cox模型均显示，与肺叶切除术相比，接受肺段切除术的患者OS和LCSS显著更差。对肿瘤≤2cm、年龄≥75岁或检查淋巴结≥7个的患者进行亚组分析，也显示肺叶切除术具有生存优势。
结论
仅年龄因素不能作为早期肺癌行肺段切除术的理由。有必要进行前瞻性随机试验来验证我们的结果。
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