Ito Hiroyuki, Suzuki Kenji, Mizutani Tomonori, Aokage Keiju, Wakabayashi Masashi, Fukuda Haruhiko, Watanabe Shun-Ichi
Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan.
Department of Thoracic Surgery, Juntendo University, Tokyo, Japan.
J Thorac Cardiovasc Surg. 2020 Jan 11. doi: 10.1016/j.jtcvs.2019.12.072.
The aim of this study was to assess long-term outcomes after lobectomy in patients with clinical T1 N0 lung cancer based on thin-section computed tomography.
We collected the data of patients with pathological adenocarcinoma who had undergone lobectomy. The patients were categorized into 4 groups according to a consolidation tumor ratio and tumor size. Groups A and B included tumors with consolidation tumor ratio ≤0.5 and size ≤3 cm. Group A consisted of tumors ≤2 cm. Group B consisted of the remaining tumors. Groups C and D consisted of tumors with consolidation tumor ratio >0.5. Group C consisted of those with tumors ≤2 cm and Group D consisted of tumors of size 2 to 3 cm. The 10-year overall survival and recurrence-free survival rates were examined.
Among the 543 patients, the 10-year overall survival was 80.4% and the 10-year recurrence-free survival rate was 77.1%. The 10-year overall survival for group A was 94.0%, 92.7% for group B, 84.1% for group C, and 68.8% for group D, and the 10-year recurrence-free survival rate for each group was 94.0%, 89.0%, 79.7%, and 66.1%, respectively. Group A + B showed better overall survival than group C + D (hazard ratio, 2.78; 95% confidence interval, 1.45-5.06) and better 10-year recurrence-free survival (hazard ratio, 2.74; 95% confidence interval, 1.55-4.88). No patient in group A had recurrence.
Those patients with total tumor size ≤3 cm and consolidation tumor ratio ≤0.5 showed excellent prognosis and might be suitable candidates for sublobar resection. If noninferior survival of segmentectomy compared with lobectomy is confirmed in an ongoing Japan Clinical Oncology Group trial, segmentectomy will be included in the standard of care.
本研究旨在基于薄层计算机断层扫描评估临床T1 N0肺癌患者肺叶切除术后的长期预后。
我们收集了接受肺叶切除术的病理腺癌患者的数据。根据实变肿瘤比例和肿瘤大小将患者分为4组。A组和B组包括实变肿瘤比例≤0.5且大小≤3 cm的肿瘤。A组由大小≤2 cm的肿瘤组成。B组由其余肿瘤组成。C组和D组由实变肿瘤比例>0.5的肿瘤组成。C组由大小≤2 cm的肿瘤组成，D组由大小为2至3 cm的肿瘤组成。检查10年总生存率和无复发生存率。
在543例患者中，10年总生存率为80.4%，10年无复发生存率为77.1%。A组10年总生存率为94.0%，B组为92.7%，C组为84.1%，D组为68.8%，每组10年无复发生存率分别为94.0%、89.0%、79.7%和66.1%。A + B组的总生存率优于C + D组（风险比，2.78；95%置信区间，1.45 - 5.06），10年无复发生存率也更好（风险比，2.74；95%置信区间，1.55 - 4.88）。A组无患者复发。
肿瘤总大小≤3 cm且实变肿瘤比例≤0.5的患者预后良好，可能是亚肺叶切除的合适候选者。如果正在进行的日本临床肿瘤学组试验证实肺段切除术与肺叶切除术的生存率无差异，肺段切除术将被纳入治疗标准。
