Thoracic Surgery Department, Respiratory Institute. Hospital Clínic, Universitat de Barcelona, Spain.
Thoracic Surgery Department, Respiratory Institute. Hospital Clínic, Universitat de Barcelona, Spain.
Lung Cancer. 2019 Aug;134:254-258. doi: 10.1016/j.lungcan.2019.06.030. Epub 2019 Jul 2.
Hiliar (pN1) and mediastinal lymph (pN2) nodal upstaging after surgery for early stage (<IIB) non-small cell lung cancer (NSCLC) is a quality marker of surgical lymphadenectomy. It has been suggested that Video-Assisted Thoracoscopic Surgery (VATS) may result in suboptimal lymphadenctomy because nodal upstaging was lower than after open thoracothomy (THO). We sought to: (1) compare the prevalence of nodal upstaging after VATS and THO in NSCLC < IIB; (2) investigate potential risk factors of nodal upstaging; and, (3) assess the impact of nodal upstaging on survival.
Retrospective analysis of all anatomical resections for NSCLC < IIB in our center (n = 323) from 2011 to 2017. The surgical procedure [THO (60.4%) or VATS (39.4%)] was chosen by the surgeon on the basis of experience and tumor characteristics (centrality and size).
Baseline characteristics were similar between the two groups except for larger and more central tumors in THO (p < 0.05). The prevalence of pN1 upstaging was higher after THO (20.5%) than after VATS (8.6%, p < 0.05), but that of pN2 was similar in both groups (6% (THO) and 6.5% (VATS). Tumor centrality was an independent risk factor for pN1. Survival after THO or VATS was similar, irrespectively of nodal upstaging.
In conclusion, VATS is as useful as THO to detect upstaging. Lower upstaging after VATS is attributable to bias selection. Central tumors are more often approached by thoracotomy and centrality is a risk factor for hiliar upstaging.
对于早期（<IIB）非小细胞肺癌（NSCLC）患者，手术治疗后出现肝门（pN1）和纵隔淋巴结（pN2）的分期升级是手术淋巴结清扫术的质量标志物。有人认为，电视辅助胸腔镜手术（VATS）可能导致淋巴结清扫术效果不理想，因为淋巴结分期升级的发生率低于开胸肺切除术（THO）。我们旨在：（1）比较 NSCLC < IIB 患者行 VATS 和 THO 后淋巴结分期升级的发生率；（2）调查淋巴结分期升级的潜在危险因素；（3）评估淋巴结分期升级对生存的影响。
对 2011 年至 2017 年在我院行解剖性切除术的所有 NSCLC < IIB 患者进行回顾性分析（n=323）。手术方式[THO（60.4%）或 VATS（39.4%）]由外科医生根据经验和肿瘤特征（中心性和大小）选择。
两组患者的基线特征除 THO 组肿瘤较大且更靠近中心（p<0.05）外，其余特征均相似。THO 组 pN1 分期升级的发生率高于 VATS 组（20.5%比 8.6%，p<0.05），但两组 pN2 分期升级的发生率相似（6%[THO]和 6.5%[VATS]）。肿瘤中心性是 pN1 分期升级的独立危险因素。THO 或 VATS 后生存情况相似，与淋巴结分期升级无关。
总之，VATS 与 THO 一样有助于发现分期升级。VATS 术后分期升级发生率较低可能与选择偏倚有关。中央型肿瘤多采用开胸手术治疗，且肿瘤的中心性是肝门分期升级的危险因素。
