Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri.
Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia.
Ann Thorac Surg. 2018 Aug;106(2):375-381. doi: 10.1016/j.athoracsur.2018.02.049. Epub 2018 Mar 23.
Lobectomy has been compared with sublobar resection for the treatment of stage IA non-small cell lung cancer (NSCLC). Accurate long-term data are lacking on the risk of recurrence in routine clinical practice. This study used a unique and representative dataset to compare recurrence, overall survival (OS), and lymph node staging between lobectomy and sublobar resection.
The American College of Surgeons performed a Special Study of the National Cancer Data Base, by reabstracting records to augment NSCLC data with enhanced information on preoperative comorbidity and cancer recurrence from 2007 to 2012. For patients treated with lobectomy or sublobar resection (wedge resection or segmentectomy) for clinical stage IA NSCLC, propensity matching and competing risks models compared 5-year OS and risk of cancer recurrence. Secondary measures included lymph nodes collected, pathologic upstaging, and surgical margin status.
A total of 1,687 patients with stage IA NSCLC were identified (1,354 who underwent lobectomy, and 333 who had sublobar resections). Propensity matching yielded 325 pairs. Lobectomy and sublobar resection groups had similar 5-year OS (61.8% vs 55.6%, p = 0.561). The sublobar group had a 39% increased risk of NSCLC recurrence (hazard ratio, 1.39; 95% confidence interval, 1.04 to 1.87). Median lymph node counts were higher for lobectomy-treated patients (7 [3, 10] vs 1 [0, 4], p < 0.001)].
In an enhanced national dataset representative of outcomes for stage IA NSCLC, sublobar resection was associated with a 39% increased risk of cancer recurrence. The majority of patients treated with sublobar resection had an inadequate lymph node assessment. These real-world results must be considered when existing clinical trial results comparing these treatments are extrapolated for clinical use.
肺叶切除术已被用于治疗ⅠA 期非小细胞肺癌（NSCLC），与亚肺叶切除术进行比较。在常规临床实践中，缺乏关于复发风险的准确长期数据。本研究使用独特且具有代表性的数据集，比较了肺叶切除术和亚肺叶切除术（楔形切除术或肺段切除术）之间的复发、总生存（OS）和淋巴结分期。
美国外科医师学院（ACoS）对国家癌症数据库（NCDB）进行了专项研究，通过重新提取记录，从 2007 年至 2012 年补充了术前合并症和癌症复发的增强信息，以扩充 NSCLC 数据。对接受肺叶切除术或亚肺叶切除术（楔形切除术或肺段切除术）治疗临床ⅠA 期 NSCLC 的患者，采用倾向评分匹配和竞争风险模型比较了 5 年 OS 和癌症复发风险。次要措施包括采集的淋巴结、病理升级和手术切缘状态。
共确定了 1687 例ⅠA 期 NSCLC 患者（1354 例接受肺叶切除术，333 例接受亚肺叶切除术）。采用倾向评分匹配后获得 325 对患者。肺叶切除术组和亚肺叶切除术组的 5 年 OS 相似（61.8% vs 55.6%，p = 0.561）。亚肺叶切除术组 NSCLC 复发风险增加 39%（风险比，1.39；95%置信区间，1.04 至 1.87）。肺叶切除术组患者的中位淋巴结计数更高（7 [3，10] 与 1 [0，4]，p < 0.001）。
在一个代表ⅠA 期 NSCLC 结局的增强型国家数据集，亚肺叶切除术与癌症复发风险增加 39%相关。大多数接受亚肺叶切除术的患者淋巴结评估不足。在将这些治疗方法的现有临床试验结果外推用于临床应用时，必须考虑这些真实世界的结果。
