Brown Lisa M, Cooke David T, Jett James R, David Elizabeth A
Section of General Thoracic Surgery, University of California, Davis Health, Sacramento, California.
Section of General Thoracic Surgery, University of California, Davis Health, Sacramento, California.
Ann Thorac Surg. 2018 Jan;105(1):207-213. doi: 10.1016/j.athoracsur.2017.07.049. Epub 2017 Nov 11.
The optimal extent of lung resection and lymph node (LN) assessment for surgical treatment of clinical stage T1aN0M0 typical carcinoid tumors is unclear. Using a cohort including only these patients, we aimed to determine the impact of extent of lung resection and LN assessment on overall survival.
Patients undergoing lobectomy or sublobar resection for clinical stage T1aN0M0 intraparenchymal typical carcinoid tumor were identified in the National Cancer Data Base from 1998 to 2012. Kaplan-Meier analysis was used to determine overall survival. A multivariable Cox proportional hazards model was used to determine independent predictors of mortality.
Of 1,495 patients, 536 (35.9%) had sublobar resection (wedge resection, n = 429; segmentectomy, n = 91) and 959 (64.2%) had lobectomy. There were 366 patients (24.5%) with no LN assessment. As tumor size increased, sublobar resection decreased and LN assessment increased. Overall, 60 patients (4.0%) were upstaged. Fifty-two patients were upstaged because of LN metastases (40 pN1, 11 pN2, and 1 pN3). The 5-year overall survival rate was 87%. It was 88% for lobectomy versus 87% for sublobar resection (p = 0.3), 65% for LN upstaging versus 89% for patients without LN upstaging, and 86% for patients with no LN assessment (p = 0.002). Independent predictors of mortality included LN upstaging, age, male sex, and Charlson comorbidity index.
For patients with clinical stage T1aN0M0 typical carcinoid, sublobar resection results in similar overall survival compared with lobectomy. However, regardless of resection type, LN assessment is important to identify LN upstaging, the strongest independent predictor of overall mortality.
对于临床分期为T1aN0M0的典型类癌进行手术治疗时，肺切除的最佳范围以及淋巴结（LN）评估尚不明确。我们纳入仅包含这些患者的队列，旨在确定肺切除范围和LN评估对总生存期的影响。
在国家癌症数据库中识别出1998年至2012年间因临床分期为T1aN0M0的实质内典型类癌而行肺叶切除术或肺段以下切除术的患者。采用Kaplan-Meier分析确定总生存期。使用多变量Cox比例风险模型确定死亡率的独立预测因素。
1495例患者中，536例（35.9%）接受了肺段以下切除术（楔形切除术，n = 429；肺段切除术，n = 91），959例（64.2%）接受了肺叶切除术。366例患者（24.5%）未进行LN评估。随着肿瘤大小增加，肺段以下切除术减少，LN评估增加。总体而言，60例患者（4.0%）分期上调。52例患者因LN转移而分期上调（40例为pN1，11例为pN2，1例为pN3）。5年总生存率为87%。肺叶切除术为88%，肺段以下切除术为87%（p = 0.3）；LN分期上调者为65%，未发生LN分期上调者为89%；未进行LN评估者为86%（p = 0.002）。死亡率的独立预测因素包括LN分期上调、年龄、男性性别和Charlson合并症指数。
对于临床分期为T1aN0M0的典型类癌患者，肺段以下切除术与肺叶切除术的总生存期相似。然而，无论切除类型如何，LN评估对于识别LN分期上调很重要，LN分期上调是总死亡率最强的独立预测因素。
