Abe Jiro, Okazaki Toshimasa, Kikuchi Naohiko, Takahashi Satomi, Sakurada Akira, Okada Yoshinori
Department of Thoracic Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiote, Natori, Miyagi Prefecture, 981-1293, Japan.
Department of Thoracic Surgery, Graduate School of Medicine, Tohoku University, 4-1 Seiryo-cho, Aoba-ward, Sendai, Miyagi Prefecture, 980-0872, Japan.
Gen Thorac Cardiovasc Surg. 2018 May;66(5):284-290. doi: 10.1007/s11748-018-0909-y. Epub 2018 Mar 21.
This study was conducted to evaluate the risk of recurrence possibly caused by preoperative bronchoscopic cancer confirmation in stage1A non-small cell lung cancer.
One hundred and seventy-nine cases of peripheral non-small cell lung cancer (including 151 adenocarcinoma) with no more than 3 cm in their tumor longer diameter were selected. All patients underwent preoperative diagnostic bronchoscopy followed by lobectomy, and were demonstrated to have pathologically free of lymph node involvement and pleural involvement. Radiological and pathological low-grade adenocarcinomas were excluded. Of 179 cases, 95 were confirmed lung cancer by bronchoscope (Group 1) and rest 84 had failed cancer confirmation by bronchoscope before surgery (Group 2). Forty-eight pairs for non-small cell lung cancer and 41 pairs for adenocarcinoma were identified from each group by propensity caliper matching. Kaplan-Meier method and log-rank test were performed on matched groups, and Cox proportional hazard model analysis was performed on whole matched cases.
Log-rank test revealed no significant inferiority of recurrence-free survival of Group 1 in both all-NSCLC and adenocarcinoma subset. Cox proportional hazard model analysis also revealed that the 'presence of preoperative bronchoscopic cancer confirmation' dose not increase risk of recurrence in both NSCLC and adenocarcinoma subset.
It is unlikely that preoperative bronchoscopic cancer confirmation would increase recurrence risk in stage1A non-small cell lung cancer; however, a future prospective study with larger cohorts would be warranted to validate the results.
本研究旨在评估术前支气管镜检查确诊癌症可能导致的ⅠA期非小细胞肺癌复发风险。
选取179例肿瘤最长径不超过3 cm的周围型非小细胞肺癌患者（包括151例腺癌患者）。所有患者均接受术前诊断性支气管镜检查，随后行肺叶切除术，术后病理证实无淋巴结转移及胸膜转移。排除影像学和病理学诊断为低级别腺癌的患者。179例患者中，95例经支气管镜确诊为肺癌（第1组），其余84例术前支气管镜检查未确诊为癌症（第2组）。通过倾向评分卡尺匹配从每组中确定48对非小细胞肺癌患者和41对腺癌患者。对匹配组进行Kaplan-Meier法和对数秩检验，并对所有匹配病例进行Cox比例风险模型分析。
对数秩检验显示，在所有非小细胞肺癌和腺癌亚组中，第1组的无复发生存率均无显著劣势。Cox比例风险模型分析还显示，“术前支气管镜检查确诊癌症”在非小细胞肺癌和腺癌亚组中均不会增加复发风险。
术前支气管镜检查确诊癌症不太可能增加ⅠA期非小细胞肺癌的复发风险；然而，未来需要开展更大样本量的前瞻性研究来验证该结果。
