Moon Youngkyu, Lee Kyo Young, Park Jae Kil
Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
World J Surg. 2017 Nov;41(11):2769-2777. doi: 10.1007/s00268-017-4075-7.
Although standard surgical treatment of stage I non-small cell lung cancer (NSCLC) is lobectomy, sublobar resection may be elected for small-sized (≤2 cm) peripheral tumors. Our aim was examine the need for completion lobectomy in the event of confirmed pleural or lymphovascular invasion after sublobar resection of NSCLC.
A total of 271 consecutive patients undergoing curative resection of stage I NSCLC ≤2 cm were reviewed retrospectively, analyzing clinicopathologic findings and survival times of those with invasion-positive (visceral pleural or lymphovascular invasion) or invasion-negative (neither visceral pleural nor lymphovascular invasion) tumors by surgical approach (sublobar resection vs lobectomy).
Aside from age and pulmonary function, clinicopathologic characteristics of the patient subsets did not differ significantly, nor did 5-year recurrence-free survival rates of surgical subsets (sublobar resection vs lobectomy) in respective tumor groups (invasion-positive 78.9 vs 79.8%, p = 0.928; invasion-negative 80.2 vs 85.4%, p = 0.505). In multivariate analysis, dissected lymph node count was the sole parameter significantly impacting recurrence of stage I invasion-positive NSCLC (hazard ratio = 0.914, 95% confidence interval 0.845-0.988; p = 0.023). Sublobar resection was not a risk factor for recurrence.
Survival rates for patients with small-sized (≤2 cm) NSCLC and visceral pleural or lymphovascular invasion did not differ significantly, whether sublobar resection or lobectomy was done. Hence, completion lobectomy is unnecessary in this setting.
虽然I期非小细胞肺癌（NSCLC）的标准手术治疗是肺叶切除术，但对于小尺寸（≤2 cm）的周围型肿瘤可选择肺段切除术。我们的目的是研究NSCLC肺段切除术后确诊存在胸膜或脉管侵犯时是否需要行补救性肺叶切除术。
回顾性分析271例连续接受I期≤2 cm NSCLC根治性切除术患者的资料，按手术方式（肺段切除术与肺叶切除术）分析肿瘤侵犯阳性（脏层胸膜或脉管侵犯）或侵犯阴性（既无脏层胸膜侵犯也无脉管侵犯）患者的临床病理特征及生存时间。
除年龄和肺功能外，各亚组患者的临床病理特征无显著差异，各肿瘤组（侵犯阳性组78.9% vs 79.8%，p = 0.928；侵犯阴性组80.2% vs 85.4%，p = 0.505）中手术亚组（肺段切除术与肺叶切除术）的5年无复发生存率也无显著差异。多因素分析显示，清扫淋巴结数目是唯一显著影响I期侵犯阳性NSCLC复发的参数（风险比=0.914，95%置信区间0.845 - 0.988；p = 0.023）。肺段切除术不是复发的危险因素。
小尺寸（≤2 cm）伴脏层胸膜或脉管侵犯的NSCLC患者，无论行肺段切除术还是肺叶切除术，生存率无显著差异。因此，在此情况下无需行补救性肺叶切除术。
