Department of Thoracic Surgery, Kyoto University Hospital, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 6068507, Japan; Institute for Advancement for Clinical and Translational Science, Kyoto University, 54, Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 6068507, Japan.
Department of Thoracic Surgery, Kyoto University Hospital, 54 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto 6068507, Japan.
Lung Cancer. 2018 Nov;125:192-197. doi: 10.1016/j.lungcan.2018.09.023. Epub 2018 Sep 29.
In high-risk operable geriatric patients undergoing palliative sublobar resection (SR), noncancerous comorbidities may contribute to unfavorable outcomes. The purpose of this retrospective study was to evaluate the perioperative safety and long-term survival of palliative SR in this patient population.
We reviewed 232 patients (141 male, 91 female) aged ≥75 years who underwent surgical resection of clinical stage I lung cancer from 2006 to 2014. The patients were divided into two groups, lobectomy and SR, and preoperative comprehensive comorbidities were assessed using the Adult Comorbidity Evaluation 27 (ACE-27) and compared between the two groups. The operative safety was compared using the Clavien-Dindo classification. Survival rates were calculated with a Kaplan-Meier model under propensity score matching, and prognostic factors were analyzed using a Cox proportional hazard model.
Lobectomy was performed in 156 patients and SR in 76 (segmentectomy, n = 50; wedge resection, n = 26). Age (p = 0.0137), tumor size on computed tomography (p < 0.0001), central tumor location (p = 0.0008), and high ACE-27 scores (p = 0.0202) were significantly associated with selection of SR. No mortality occurred, and the incidence of Grade 3b or greater postoperative complications in lobectomy and SR was 5.1% and 5.3%, respectively. According to the analysis of propensity score-matched patients (n = 57, tumor size = 23 mm, and consolidation/tumor ratio = 83%), the 5-year survival rate in lobectomy and SR was 81.1% and 73.5%, respectively (p = 0.4374). The ACE-27 score was a more significant prognostic factor than the type of surgical procedure, as well as consolidation/tumor ratio and nodal metastatic status.
The severity of preoperative comorbidities is a significant prognostic factor, and SR as a compromise surgical procedure may provide promising short- and long-term outcomes in selected geriatric patients with clinical stage I lung cancer.
在接受姑息性亚肺叶切除术（SR）的高危可手术老年患者中，非癌症合并症可能导致不良结局。本回顾性研究的目的是评估该患者人群接受姑息性 SR 的围手术期安全性和长期生存情况。
我们回顾了 2006 年至 2014 年间接受手术切除临床 I 期肺癌的 232 名年龄≥75 岁的患者（141 名男性，91 名女性）。患者被分为肺叶切除术组和 SR 组，并使用成人合并症评估 27 项（ACE-27）评估术前综合合并症，并比较两组之间的差异。使用 Clavien-Dindo 分类比较手术安全性。使用倾向评分匹配下的 Kaplan-Meier 模型计算生存率，并使用 Cox 比例风险模型分析预后因素。
156 例患者行肺叶切除术，76 例患者行 SR（其中 50 例行节段切除术，26 例行楔形切除术）。年龄（p=0.0137）、CT 上的肿瘤大小（p<0.0001）、中央肿瘤位置（p=0.0008）和高 ACE-27 评分（p=0.0202）与 SR 的选择显著相关。无死亡发生，肺叶切除术和 SR 的术后 3b 级或更高级别并发症发生率分别为 5.1%和 5.3%。根据倾向评分匹配患者（n=57，肿瘤大小=23mm，实变/肿瘤比=83%）的分析，肺叶切除术和 SR 的 5 年生存率分别为 81.1%和 73.5%（p=0.4374）。ACE-27 评分是比手术类型、实变/肿瘤比和淋巴结转移状态更重要的预后因素。
术前合并症的严重程度是一个重要的预后因素，SR 作为一种妥协的手术方式，可为选择的临床 I 期肺癌老年患者提供有希望的短期和长期结果。
