Department of Cardiothoracic Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA.
Department of Cardiothoracic Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA.
Clin Lung Cancer. 2019 Jul;20(4):e463-e469. doi: 10.1016/j.cllc.2019.03.006. Epub 2019 Apr 1.
Segmentectomy for well-selected early stage non-small-cell lung carcinoma (NSCLC) has been shown to have similar oncologic outcomes and survival to lobectomy. However, these data are based on the presumption that the disease is node negative. Few data exist regarding the risk factors for and the outcomes of patients with disease treated with segmentectomy that is found to be node positive. We sought to determine the risk factors for and outcomes of clinical stage I NSCLC patients who are treated with segmentectomy but are determined to be node positive.
We queried patients with clinical stage I NSCLC ≤ 3 cm within the National Cancer Data Base between 2004 and 2014 who were treated with segmentectomy or lobectomy and found to have positive nodes. Kaplan-Meier curves with log-rank tests were used to compare overall survival (OS) between segmentectomy and lobectomy. For comparison only, segmentectomy patients with pathologically node-negative disease were identified to determine predictors of node positivity after segmentectomy via multivariable logistic regression.
A total of 4556 patients with node-positive disease were identified, comprising 115 segmentectomy patients and 4441 lobectomy patients. Multivariable analysis identified increasing tumor size, squamous-cell histology, and increasing number lymph nodes sampled as significant predictors of node positivity after segmentectomy. There was no difference in OS between segmentectomy and lobectomy, with 3-year OS rates of 66.3% and 68.1%, respectively (P = .723).
There are discrete risk factors for discovering positive nodes after segmentectomy. Segmentectomy is associated with similar OS compared to lobectomy for clinical stage I NSCLC found to be node positive.
对于精心挑选的早期非小细胞肺癌（NSCLC）患者，段切除术与肺叶切除术相比，其肿瘤学结果和生存率相似。然而，这些数据是基于假定疾病为淋巴结阴性。关于经段切除术治疗且淋巴结阳性的患者的疾病风险因素和结局的数据很少。我们旨在确定接受段切除术但淋巴结阳性的 I 期 NSCLC 患者的风险因素和结局。
我们在 2004 年至 2014 年间在国家癌症数据库中查询了临床 I 期 NSCLC 患者，这些患者的肿瘤直径≤3cm，接受了段切除术或肺叶切除术，且发现有阳性淋巴结。使用 Kaplan-Meier 曲线和对数秩检验比较段切除术和肺叶切除术之间的总生存率（OS）。仅为了比较，我们确定了具有病理淋巴结阴性疾病的段切除术患者，以通过多变量逻辑回归确定段切除术后淋巴结阳性的预测因素。
共确定了 4556 例淋巴结阳性疾病患者，包括 115 例段切除术患者和 4441 例肺叶切除术患者。多变量分析确定肿瘤大小增加、鳞状细胞组织学和取样的淋巴结数量增加是段切除术后淋巴结阳性的显著预测因素。段切除术和肺叶切除术之间的 OS 没有差异，3 年 OS 率分别为 66.3%和 68.1%（P=0.723）。
段切除术后发现阳性淋巴结有明确的风险因素。对于发现淋巴结阳性的 I 期 NSCLC，段切除术与肺叶切除术的 OS 相似。
