Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Sichuan University, Chengdu, People's Republic of China.
Ann Surg Oncol. 2019 Jul;26(7):2044-2052. doi: 10.1245/s10434-019-07368-x. Epub 2019 Apr 22.
The aim of this study was to compare survival outcomes between non-small cell lung cancer (NSCLC) patients with or without 4L node dissection (4LND) and to evaluate the potential patient population who will particularly benefit from 4LND.
Between January 2009 and December 2015, a total of 2063 patients with primary left-sided NSCLC in the Western China Lung Cancer Database were initially reviewed. After exclusion, 1064 patients were enrolled in this study. A total of 460 patients with 4LND (4LND group) were matched with 460 patients without 4LND (4LND group) using propensity-matched analysis. Disease-free survival (DFS) and overall survival (OS) were analyzed.
The metastasis rate of station 4L was 14.6%. Patients with 4LND showed higher DFS (5-year DFS 52.6% vs. 46.7%; hazard ratio [HR] 1.25, 95% confidence interval [CI] 1.03-1.50; p = 0.022) and OS (5-year OS 65.8% vs. 56.3%; HR 1.36, 95% CI 1.10-1.69; p = 0.006) than patients without 4LND. In the multivariate analysis, patients without 4LND (HR 1.33, 95% CI 1.07-1.66; p = 0.011), tumor size > 3 cm, lymph node metastasis, and pathologic stage higher than stage I were independent prognostic factors for poor OS. Subgroup analysis according to pathologic TNM stage and N stage showed that stage II, IIIA, and N2 disease indicated better survival outcomes in the 4LND group (p = 0.050, p = 0.016, and p = 0.008, respectively).
Performing 4LND may bring survival benefits to patients with left-sided NSCLC. We suggest 4LND as a standard procedure for left-sided NSCLC patients with stage II or advanced stage disease.
本研究旨在比较接受与不接受 4L 淋巴结清扫术（4LND）的非小细胞肺癌（NSCLC）患者的生存结局，并评估特别受益于 4LND 的潜在患者人群。
2009 年 1 月至 2015 年 12 月，对西方肺癌数据库中 2063 例原发性左侧 NSCLC 患者进行了初步回顾。排除后，共有 1064 例患者纳入本研究。460 例接受 4LND（4LND 组）的患者与 460 例未接受 4LND（4LND 组）的患者采用倾向匹配分析进行匹配。分析无病生存期（DFS）和总生存期（OS）。
4L 站转移率为 14.6%。接受 4LND 的患者 DFS 更高（5 年 DFS 52.6%比 46.7%；风险比[HR]1.25，95%置信区间[CI]1.03-1.50；p=0.022），OS 更高（5 年 OS 65.8%比 56.3%；HR 1.36，95%CI 1.10-1.69；p=0.006）。多变量分析显示，未行 4LND（HR 1.33，95%CI 1.07-1.66；p=0.011）、肿瘤直径>3cm、淋巴结转移和病理分期高于 I 期是 OS 不良的独立预后因素。根据病理 TNM 分期和 N 分期的亚组分析显示，Ⅱ期、ⅢA 期和 N2 期患者在 4LND 组的生存结局更好（p=0.050、p=0.016 和 p=0.008）。
对左侧 NSCLC 患者行 4LND 可能带来生存获益。我们建议对Ⅱ期或晚期疾病的左侧 NSCLC 患者行 4LND 作为标准术式。
