Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Eight-Year Program Clinical Medicine, Shanghai Medical College, Fudan University, Shanghai, China.
Ann Thorac Surg. 2018 Sep;106(3):880-887. doi: 10.1016/j.athoracsur.2018.04.071. Epub 2018 May 28.
The optimal surgical approach for metachronous second primary lung cancer (MSPLC) has not been well established yet. In this study, survival outcome of lobectomy was compared with sublobectomy for MSPLC.
A retrospective study was conducted based on the Surveillance, Epidemiology, and End Results database. Propensity score matching was used to reduce the potential bias caused by the variance of the clinicopathologic features of the first and second lung cancer. The effect of lobectomy and sublobectomy for MSPLC was assessed and explored in subgroup analyses.
We identified 1,392 MSPLC patients, and 454 pairs of patients were matched. Lobectomy was associated with a significantly better survival (p = 0.023). Subgroup analyses showed that lobectomy achieved a significantly better prognosis if previous lung cancer was stage I, whereas sublobectomy had advantages in patients with initial stage III cancer. Moreover, patients with lobectomy had a significantly better prognosis in N0 disease but not in N1 or N2. Stratified by tumor size, the prognosis of sublobectomy was comparable to lobectomy for tumors sized 1 cm or smaller. Lobectomy was associated with a better survival in tumors sized 1 to 2 cm, although without statistical significance. For tumors sized 2 to 3 cm, lobectomy conferred a significantly better survival.
This study indicates that lobectomy is still a valid choice for MSPLC. Sublobectomy has value and shows equivalency in tumors sized 2 cm or smaller. For patients with advanced disease or at high risk, additional studies are needed to explore the value of sublobectomy.
对于同时性第二原发肺癌（MSPLC），尚未确定最佳的手术方法。本研究旨在比较肺叶切除术与亚肺叶切除术治疗 MSPLC 的生存结果。
本研究基于监测、流行病学和最终结果数据库进行回顾性研究。采用倾向评分匹配法，以减少首次和第二次肺癌的临床病理特征差异造成的潜在偏倚。评估并探讨了肺叶切除术和亚肺叶切除术治疗 MSPLC 的效果。
共纳入 1392 例 MSPLC 患者，匹配后有 454 对患者。肺叶切除术与更好的生存相关（p=0.023）。亚组分析显示，对于首次肺癌为Ⅰ期的患者，肺叶切除术具有显著更好的预后，而对于初始为Ⅲ期的患者，亚肺叶切除术具有优势。此外，对于 N0 疾病患者，肺叶切除术具有显著更好的预后，但对于 N1 或 N2 疾病患者则不然。按肿瘤大小分层，肿瘤直径 1 cm 或以下时，亚肺叶切除术的预后与肺叶切除术相当。肿瘤直径为 1 至 2 cm 时，肺叶切除术与更好的生存相关，尽管无统计学意义。对于肿瘤直径为 2 至 3 cm 的患者，肺叶切除术具有显著更好的生存。
本研究表明，肺叶切除术仍然是 MSPLC 的有效选择。亚肺叶切除术在直径 2 cm 或以下的肿瘤中具有价值，且与肺叶切除术等效。对于晚期疾病或高危患者，需要进一步研究来探讨亚肺叶切除术的价值。
