Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Republic of Korea.
Respirology. 2018 Jul;23(7):695-703. doi: 10.1111/resp.13277. Epub 2018 Feb 21.
Standard surgical management for early stage lung cancer is lobectomy with mediastinal lymph node dissection. The feasibility of limited resection remains controversial; we retrospectively assessed lung cancer-specific survival (LCSS) and overall survival (OS) in early stage non-small cell lung cancer (NSCLC) to evaluate whether segmentectomy is comparable to standard lobectomy.
Patients with primary NSCLC of 20 mm or less who were diagnosed from 2000 to 2014 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. To compare the two surgical interventions, a propensity score analysis was performed between lobectomy and segmentectomy.
Of the 15 358 patients analysed, there were 14 549 lobectomies and 809 segmentectomies. The 5-year OS was 76% for the lobectomy group and 74.4% for the segmentectomy group. There were no significant differences in OS or LCSS among patients who underwent lobectomy versus segmentectomy, as demonstrated by the propensity-matched hazard ratio (HR) for OS (HR: 1.195, 95% CI: 0.993-1.439) and LCSS (HR: 1.124, 95% CI: 0.860-1.469). The inverse propensity-weighted analysis also supported these results. Segmentectomy was more likely to be performed in elderly patients. In the subset of patients aged ≥75 years, the segmentectomy group demonstrated comparable OS (HR: 1.17, 95% CI: 0.87-1.58, P = 0.31) and LCSS (HR: 0.94, 95% CI: 0.59-1.51, P = 0.81), compared with the lobectomy group.
Equivalent OS and LCSS were demonstrated in patients with primary NSCLC of 20 mm or less without lymph node or distant metastasis.
早期肺癌的标准手术治疗是肺叶切除术联合纵隔淋巴结清扫术。局限性切除术的可行性仍存在争议；我们回顾性评估了早期非小细胞肺癌（NSCLC）的肺癌特异性生存（LCSS）和总生存（OS），以评估段切除术是否与标准肺叶切除术相当。
从监测、流行病学和最终结果（SEER）数据库中提取 2000 年至 2014 年间诊断为 20mm 或更小原发性 NSCLC 的患者。为了比较两种手术干预，对肺叶切除术和段切除术进行了倾向评分分析。
在分析的 15358 例患者中，有 14549 例肺叶切除术和 809 例段切除术。肺叶切除术组的 5 年 OS 为 76%，段切除术组为 74.4%。倾向评分匹配的 OS 风险比（HR）（HR：1.195，95%CI：0.993-1.439）和 LCSS（HR：1.124，95%CI：0.860-1.469）表明，两组患者的 OS 和 LCSS 无显著差异。逆概率加权分析也支持这些结果。段切除术更可能在老年患者中进行。在年龄≥75 岁的患者亚组中，段切除术组的 OS（HR：1.17，95%CI：0.87-1.58，P=0.31）和 LCSS（HR：0.94，95%CI：0.59-1.51，P=0.81）与肺叶切除术组相当。
在无淋巴结或远处转移的 20mm 或更小原发性 NSCLC 患者中，段切除术与肺叶切除术具有相当的 OS 和 LCSS。
