Wang Yiyang, Wang Rui, Zheng Difan, Han Baohui, Zhang Jie, Zhao Heng, Luo Jizhuang, Zheng Jiajie, Chen Tianxiang, Huang Qingyuan, Sun Yihua, Chen Haiquan
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Road, Shanghai, 200032, China.
J Cancer Res Clin Oncol. 2017 Oct;143(10):2095-2104. doi: 10.1007/s00432-017-2452-0. Epub 2017 Jun 14.
This retrospective study was designed to find out the potential indications of completion lobectomy (CL) during wedge resection (WR) operation among patients with lung adenocarcinoma (ADC) ≤3 cm, by the use of Shanghai Chest Hospital Lung Cancer Database.
There were totally 1938 patients in this study, including 746 WRs and 1192 CLs. The propensity score matching (PSM) was performed to minimize the effect of confounders. Univariable and multivariable cox regressions were analyzed to discover the independent risk factors of recurrence-free survival (RFS) and overall survival (OS). Subgroup analysis and Kaplan-Meier survival curves were performed if necessary.
The 5-year RFS (86.1 vs 91.5%, p = 0.001 for unmatched group; 84 v 92%, p < 0.001 for PSM group) and OS (83.6 vs 91.7%, p < 0.001 for unmatched group; 81.6 vs 88.2%, p < 0.001 for PSM group) all indicated a better prognosis when conducting CL. Subgroup analysis suggested that WR was appropriate for non-invasive ADC. Three prognostic factors (sex, surgical approach and pleural invasion) were correlated with RFS and two (sex and surgical approach) corresponded with OS in invasive ADC through multivariable analysis. Non-lepidic-predominant component showed a better RFS and OS when CL was operated after WR in the subgroup of invasive ADC.
CL was an appropriate remediation to WR when the existence of invasive ADC, especially non-lepidic-predominant one. While WR could be applied if non-invasive ADC was confirmed. Whether lepidic-predominant adenocarcinoma was fit for WR needed further study.
本回顾性研究旨在通过使用上海胸科医院肺癌数据库，找出肺腺癌（ADC）≤3 cm患者在楔形切除术（WR）过程中进行肺叶完整切除术（CL）的潜在指征。
本研究共有1938例患者，包括746例WR和1192例CL。进行倾向评分匹配（PSM）以尽量减少混杂因素的影响。分析单变量和多变量cox回归，以发现无复发生存期（RFS）和总生存期（OS）的独立危险因素。必要时进行亚组分析和Kaplan-Meier生存曲线分析。
5年RFS（未匹配组为86.1%对91.5%，p = 0.001；PSM组为84%对92%，p < 0.001）和OS（未匹配组为83.6%对91.7%，p < 0.001；PSM组为81.6%对88.2%，p < 0.001）均表明进行CL时预后更好。亚组分析表明，WR适用于非侵袭性ADC。通过多变量分析，在侵袭性ADC中，三个预后因素（性别、手术方式和胸膜侵犯）与RFS相关，两个因素（性别和手术方式）与OS相关。在侵袭性ADC亚组中，当WR后进行CL时，非鳞屑为主型成分显示出更好的RFS和OS。
当存在侵袭性ADC，尤其是非鳞屑为主型时，CL是WR的合适补救措施。而如果确认是非侵袭性ADC，则可应用WR。鳞屑为主型腺癌是否适合WR需要进一步研究。
