Zhong Chenxi, Sakurai Hiroyuki, Wei Shenhai, Fang Wentao, Asamura Hisao
Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.
Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan.
J Thorac Dis. 2018 Feb;10(2):991-998. doi: 10.21037/jtd.2018.01.63.
Segmentectomy for small-sized stage Ia non-small cell lung cancer (NSCLC) may be comparable to lobectomy regarding prognosis and local recurrence. However, the clinical results of wedge resection for such patients are still under debate. In this international multicenter study, we retrospectively studied surgical outcomes of sublobar resections for patients with small-sized stage Ia adenocarcinoma to elucidate whether wedge resection is inferior to segmentectomy for such patients.
Between March 2000 and August 2011, 173 patients underwent segmentectomy (group I), and 181 patients underwent wedge resection (group II) at three institutions in Japan and China. The tumor was defined as Ground glass opacity (GGO) type when the proportion of GGO was equal or more than 50% in HRCT, while solid type was defined as the proportion of GGO less than 50%. Clinicopathologic factors, local recurrence rate, and survival were compared.
The two groups were similar in sex, comorbidity rate, and composition of Noguchi type. There was no in-hospital death. Postoperative morbidity rate of group I was significantly higher than that of group II (11.0% 2.2%, P=0.016). Local recurrence rates were similar between group I (4.0%) and group II (4.4%), while no patient with GGO type tumors had local recurrence. Overall and lung cancer-specific survivals were of no significant difference between the two groups. Lung cancer-specific survival rates at 10 years were significantly better in patients with GGO type tumors than in those with solid type tumors (100% 76.9%, P<0.001). In multivariate Cox regression analyses of lung cancer-specific survival of all patients, GGO type turned out to be an independent prognostic factor, while extent of resection did not have any influence.
Our data suggests that sublobar resection is an acceptable procedure for small lung adenocarcinomas without nodal involvement, and wedge resection may not be inferior to segmentectomy for small GGO type tumors. Our study also demonstrates that GGO type is an independent prognostic factor of disease-free survival for small-sized (diameter ≤2.0 cm) stage Ia lung adenocarcinomas.
对于小尺寸的Ⅰa期非小细胞肺癌（NSCLC），肺段切除术在预后和局部复发方面可能与肺叶切除术相当。然而，此类患者楔形切除术的临床结果仍存在争议。在这项国际多中心研究中，我们回顾性研究了小尺寸Ⅰa期腺癌患者亚肺叶切除术的手术结果，以阐明楔形切除术对此类患者是否劣于肺段切除术。
2000年3月至2011年8月期间，日本和中国的三家机构中，173例患者接受了肺段切除术（Ⅰ组），181例患者接受了楔形切除术（Ⅱ组）。当高分辨率计算机断层扫描（HRCT）中磨玻璃密度影（GGO）的比例等于或超过50%时，肿瘤被定义为GGO型，而实性型定义为GGO比例小于50%。比较了临床病理因素、局部复发率和生存率。
两组在性别、合并症发生率和野口类型构成方面相似。无院内死亡。Ⅰ组的术后发病率显著高于Ⅱ组（11.0%对2.2%，P = 0.016）。Ⅰ组（4.0%）和Ⅱ组（4.4%）的局部复发率相似，而GGO型肿瘤患者均无局部复发。两组的总生存率和肺癌特异性生存率无显著差异。GGO型肿瘤患者的10年肺癌特异性生存率显著高于实性型肿瘤患者（100%对76.9%，P < 0.001）。在所有患者肺癌特异性生存的多因素Cox回归分析中，GGO型被证明是一个独立的预后因素，而切除范围没有任何影响。
我们的数据表明，亚肺叶切除术对于无淋巴结受累的小肺腺癌是一种可接受的手术方式，对于小GGO型肿瘤，楔形切除术可能并不劣于肺段切除术。我们的研究还表明，GGO型是小尺寸（直径≤2.0 cm）Ⅰa期肺腺癌无病生存的独立预后因素。
