Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY.
Department of Healthcare Policy and Research, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY.
J Thorac Cardiovasc Surg. 2019 Jun;157(6):2454-2465.e1. doi: 10.1016/j.jtcvs.2019.01.136. Epub 2019 Feb 28.
Sublobar resection (SLR) is an alternative to lobectomy for early non-small cell lung cancer. Comparative effectiveness of these 2 approaches might be modified by the extent of lymph node dissection.
We utilized the Surveillance, Epidemiology, and End Results Program-Medicare dataset to identify patients with stage I non-small cell lung cancer aged 66 years or older with tumor size ≤2 cm. We compared patient characteristics with t tests for continuous variables and χ tests for categorical variables. Kaplan-Meier curves were constructed to determine overall survival (OS) and cancer-specific survival (CSS). We evaluated OS and CSS among propensity-matched cohorts undergoing lobectomy versus SLR, particularly as it related to extent of lymphadenectomy.
Among 2757 lobectomies and 1229 SLR procedures performed for stage I tumors ≤2 cm, we propensity-matched 1124 patients from each group. Patients undergoing SLR were more likely to have no lymph nodes sampled (46.9% vs 6.4%; P < .001). OS (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.29-1.69) and CSS (HR, 2.06; 95% CI, 1.41-3.02) were worse following SLR. When propensity-matched cohorts of patients with at least 1 lymph node removed (n = 567 each group) were examined, the HRs for survival for SLR decreased (OS HR, 1.38; 95% CI, 1.12-1.69; CSS HR, 1.58; 95% CI, 0.97-2.57). Finally, when cohorts were propensity matched for ≥9 lymph nodes examined (n = 103 each group), there was no difference in OS (HR, 0.84; 95% CI, 0.50-1.39) or CSS (HR, 1.10; 95% CI, 0.35-3.41).
SLR leads to fewer lymph node removed and is associated with inferior survival compared with lobectomy. A more extensive lymphadenectomy may be associated with equivalent survival between matched patients undergoing SLR and lobectomy.
亚肺叶切除术（SLR）是早期非小细胞肺癌肺叶切除术的替代方法。这些方法的比较效果可能会因淋巴结清扫的范围而改变。
我们利用监测、流行病学和最终结果计划-医疗保险数据集，确定年龄在 66 岁或以上、肿瘤大小≤2cm 的 I 期非小细胞肺癌患者。我们通过 t 检验比较连续变量和卡方检验比较分类变量来比较患者特征。绘制 Kaplan-Meier 曲线以确定总生存期（OS）和癌症特异性生存期（CSS）。我们评估了行肺叶切除术与 SLR 的倾向匹配队列中的 OS 和 CSS，特别是与淋巴结清扫范围有关的情况。
在 2757 例肺叶切除术和 1229 例 SLR 手术中，我们对每组的 1124 名患者进行了倾向匹配。行 SLR 的患者淋巴结取样的可能性较小（46.9% vs 6.4%；P<0.001）。SLR 后 OS（风险比[HR]，1.48；95%置信区间[CI]，1.29-1.69）和 CSS（HR，2.06；95%CI，1.41-3.02）更差。当检查至少有 1 个淋巴结被切除的倾向匹配队列（每组 n=567）时，SLR 生存率的 HR 降低（OS HR，1.38；95%CI，1.12-1.69；CSS HR，1.58；95%CI，0.97-2.57）。最后，当对检查≥9 个淋巴结的队列进行倾向匹配时（每组 n=103），OS 无差异（HR，0.84；95%CI，0.50-1.39）或 CSS（HR，1.10；95%CI，0.35-3.41）。
SLR 导致淋巴结切除较少，与肺叶切除术相比，生存结果较差。更广泛的淋巴结清扫术可能与接受 SLR 和肺叶切除术的匹配患者的生存结果相当。
