楔形切除术在支气管类癌（BC）肿瘤中的作用：监测、流行病学和最终结果（SEER）数据库分析
Role of wedge resection in bronchial carcinoid (BC) tumors: SEER database analysis.
作者信息
Rahouma Mohamed, Kamel Mohamed, Narula Navneet, Nasar Abu, Harrison Sebron, Lee Benjamin, Stiles Brendon M, Lau Christopher, Altorki Nasser K, Port Jeffrey L
机构信息
Cardiothoracic Department, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA.
Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
出版信息
J Thorac Dis. 2019 Apr;11(4):1355-1362. doi: 10.21037/jtd.2019.03.89.
BACKGROUND
There is a paucity of data regarding the role of wedge resection (WR) in the management of bronchial carcinoid (BC) tumors. In this study, we queried the Surveillance, Epidemiology, and End Results (SEER) database to compare the oncologic outcomes of patients with BC tumors treated with WR or anatomic resection.
METHODS
The SEER database was retrospectively reviewed for patients with BC treated with surgical resection between 1973-2013. Patients who underwent WR were compared to those who underwent lobectomy or segmentectomy (Lob/Seg). Patients with multiple primaries and those who underwent pneumonectomy or have an unspecified surgical procedure were excluded. Differences in demographics and clinicopathological data were compared using Chi (χ) test or Mann Whitney U test. Overall and cancer specific survival (OS, CSS) were estimated using Kaplan-Meier method and differences were compared using log-rank test. Cox-regression multivariable analysis (MVA) was performed to explore factors associated with worse CSS. Propensity-score matching analysis was done to compare survival differences between WR and Lob/Seg.
RESULTS
A total of 22,350 patients with BC were identified, of them 4,450 met our inclusion criteria (3,511 Lob/Seg, 939 WR). The median age was 59.0 years [interquartile range (IQR) =49.0-68.0], 67.6% were females and the median tumor size was 2 cm (1.5-3 cm). 4,119 patients had typical carcinoid (TC) and 331 had atypical carcinoid (AC). WR was performed more frequently in elderly patients, females, lower lobe tumors, TC's and in earlier stage disease. For patients with TC, there was no difference in CSS between WR and Lob/Seg in both the entire cohort (P=0.654) and in the propensity matched groups (P=0.900). However, for patients with AC, Lob/Seg was associated with better CSS compared to WR both in the entire cohort (P<0.001) and in the propensity matched groups (P=0.001). On MVA of the entire cohort, elderly patients, males, blacks, AC and advanced stages had worse CSS. While, the type of the procedure (WR Lob/Seg) was not associated with CSS (HR =1.16, 95% CI: 0.85-1.60).
CONCLUSIONS
A WR may offer equivalent CSS in well-selected patients with early-stage TC. An anatomic resection appears warranted in AC.
背景
关于楔形切除术（WR）在支气管类癌（BC）肿瘤治疗中的作用，相关数据较少。在本研究中，我们查询了监测、流行病学和最终结果（SEER）数据库，以比较接受WR或解剖性切除术治疗的BC肿瘤患者的肿瘤学结局。
方法
对1973 - 2013年间接受手术切除的BC患者的SEER数据库进行回顾性分析。将接受WR的患者与接受肺叶切除术或肺段切除术（Lob/Seg）的患者进行比较。排除有多个原发性肿瘤以及接受全肺切除术或手术方式未明确的患者。使用卡方（χ）检验或曼 - 惠特尼U检验比较人口统计学和临床病理数据的差异。采用Kaplan - Meier方法估计总生存率和癌症特异性生存率（OS，CSS），并使用对数秩检验比较差异。进行Cox回归多变量分析（MVA）以探索与较差CSS相关的因素。进行倾向得分匹配分析以比较WR和Lob/Seg之间的生存差异。
结果
共识别出22350例BC患者，其中4450例符合我们的纳入标准（3511例Lob/Seg，939例WR）。中位年龄为59.0岁[四分位间距（IQR）=49.0 - 68.0]，67.6%为女性，中位肿瘤大小为2 cm（1.5 - 3 cm）。4119例患者为典型类癌（TC），331例为非典型类癌（AC）。WR在老年患者、女性、下叶肿瘤、TC患者以及疾病早期更为频繁地进行。对于TC患者，在整个队列（P = 0.654）和倾向得分匹配组（P = 0.900）中，WR和Lob/Seg之间的CSS无差异。然而，对于AC患者，在整个队列（P < 0.001）和倾向得分匹配组（P = 0.001）中，与WR相比，Lob/Seg与更好的CSS相关。在整个队列的MVA中，老年患者、男性、黑人、AC患者和晚期患者的CSS较差。而手术方式（WR与Lob/Seg）与CSS无关（HR = 1.16，95% CI：0.85 - 1.60）。
结论
对于精心挑选的早期TC患者，WR可能提供相当的CSS。对于AC患者，解剖性切除术似乎是必要的。
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