Department of Surgery, NorthShore University HealthSystem, Evanston, Ill; Pritzker School of Medicine, The University of Chicago, Chicago, Ill.
Bioinformatics and Research Core, NorthShore University HealthSystem, Evanston, Ill.
J Thorac Cardiovasc Surg. 2018 Jul;156(1):380-391.e2. doi: 10.1016/j.jtcvs.2018.02.095. Epub 2018 Mar 13.
Very few studies have examined the quality of wedge resection in patients with non-small cell lung cancer. Using the National Cancer Database, we evaluated whether the quality of wedge resection affects overall survival in patients with early disease and how these outcomes compare with those of patients who receive stereotactic radiation.
We identified 14,328 patients with cT1 to T2, N0, M0 disease treated with wedge resection (n = 10,032) or stereotactic radiation (n = 4296) from 2005 to 2013 and developed a subsample of propensity-matched wedge and radiation patients. Wedge quality was grouped as high (negative margins, >5 nodes), average (negative margins, ≤5 nodes), and poor (positive margins). Overall survival was compared between patients who received wedge resection of different quality and those who received radiation, adjusting for demographic and clinical variables.
Among patients who underwent wedge resection, 94.6% had negative margins, 44.3% had 0 nodes examined, 17.1% had >5 examined, and 3.0% were nodally upstaged; 16.7% received a high-quality wedge, which was associated with a lower risk of death compared with average-quality resection (adjusted hazard ratio [aHR], 0.74; 95% confidence interval [CI], 0.67-0.82). Compared with stereotactic radiation, wedge patients with negative margins had significantly reduced hazard of death (>5 nodes: aHR, 0.50; 95% CI, 0.43-0.58; ≤5 nodes: aHR, 0.65; 95% CI, 0.60-0.70). There was no significant survival difference between margin-positive wedge and radiation.
Lymph nodes examined and margins obtained are important quality metrics in wedge resection. A high-quality wedge appears to confer a significant survival advantage over lower-quality wedge and stereotactic radiation. A margin-positive wedge appears to offer no benefit compared with radiation.
很少有研究检查非小细胞肺癌患者楔形切除术的质量。我们使用国家癌症数据库，评估早期疾病患者楔形切除术的质量是否影响总生存率，以及这些结果与接受立体定向放疗患者的结果相比如何。
我们从 2005 年至 2013 年确定了 14328 例接受楔形切除术（n=10032）或立体定向放疗（n=4296）治疗的 cT1 至 T2、N0、M0 疾病患者，并建立了倾向匹配的楔形切除术和放疗患者的亚样本。楔形质量分为高（阴性切缘，>5 个淋巴结）、中（阴性切缘，≤5 个淋巴结）和差（阳性切缘）。在调整了人口统计学和临床变量后，比较了不同质量楔形切除术和放疗患者之间的总生存率。
在接受楔形切除术的患者中，94.6%的患者切缘阴性，44.3%的患者检查了 0 个淋巴结，17.1%的患者检查了>5 个淋巴结，3.0%的患者淋巴结升级；16.7%的患者接受了高质量的楔形切除术，与中质量切除术相比，死亡风险降低（调整后的危险比[aHR]，0.74；95%置信区间[CI]，0.67-0.82）。与立体定向放疗相比，楔形切除术阴性切缘患者的死亡风险显著降低（>5 个淋巴结：aHR，0.50；95%CI，0.43-0.58；≤5 个淋巴结：aHR，0.65；95%CI，0.60-0.70）。阳性切缘楔形切除术与放疗之间的生存差异无统计学意义。
楔形切除术中检查的淋巴结和获得的切缘是重要的质量指标。高质量的楔形切除术似乎比低质量的楔形切除术和立体定向放疗有显著的生存优势。与放疗相比，阳性切缘楔形切除术似乎没有获益。
