Kocaman Gökhan, Yenigün Mustafa Bülent, Elhan Atilla Halil, Sak Serpil Dizbay, Hamzayev Elvin, Enön Serkan, Kayı Cangır Ayten, Yüksel Cabir
Department of Thoracic Surgery, Ankara University School of Medicine, Ankara, Turkey.
Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey.
Turk Gogus Kalp Damar Cerrahisi Derg. 2018 Sep 16;26(4):614-620. doi: 10.5606/tgkdc.dergisi.2018.15846. eCollection 2018 Oct.
This study aims to identify the prognostic factors for stage I lung adenocarcinoma and to evaluate the surgical management of subsolid nodules.
The study included 133 patients (90 males, 43 females; mean age 64.9 years; range, 29 to 82 years) who had undergone operation in our clinic for stage I lung adenocarcinoma between January 2007 and December 2015. Clinical, radiological and pathological data were retrospectively evaluated and their effects on recurrence and survival were examined by Kaplan-Meier and Cox regression analyses.
Comparing the histopathological tumor types according to the pathological tumors size, we determined that the prevalence of invasive adenocarcinoma significantly increased with increasing tumor size (p<0.001). For all nodules, a tumor disappearance rate lower than 25% negatively influenced disease-free survival and a maximum standardized uptake value higher than 5.6 negatively influenced overall survival (p=0.027 for both). The grouping, which was performed considering the maximum standardized uptake value 5.6 as the cut-off value, was an independent prognostic factor for overall survival (hazard ratio: 5.973, 95% confidence interval: 1.186-30.073, p=0.03). Five-year overall survival rate was statistically significantly higher in patients who underwent wedge resection or segmentectomy for subsolid nodules compared to those who underwent lobectomy (100% vs. 79.3%, p=0.044).
Sublobar resections can be safely performed in subsolid nodules smaller than 2 cm in diameter with tumor disappearance rate ≥25% and maximum standardized uptake value ≤5.6.
本研究旨在确定Ⅰ期肺腺癌的预后因素，并评估亚实性结节的外科治疗方法。
本研究纳入了2007年1月至2015年12月期间在我院接受手术治疗的133例Ⅰ期肺腺癌患者（男性90例，女性43例；平均年龄64.9岁；范围29至82岁）。对临床、影像学和病理数据进行回顾性评估，并通过Kaplan-Meier和Cox回归分析检验其对复发和生存的影响。
根据病理肿瘤大小比较组织病理学肿瘤类型，我们确定浸润性腺癌的患病率随肿瘤大小增加而显著增加（p<0.001）。对于所有结节，肿瘤消失率低于25%对无病生存有负面影响，最大标准化摄取值高于5.6对总生存有负面影响（两者p均=0.027）。以最大标准化摄取值5.6为临界值进行分组，是总生存的独立预后因素（风险比：5.973，95%置信区间：1.186 - 30.073，p = 0.03）。对于亚实性结节，接受楔形切除术或肺段切除术的患者5年总生存率在统计学上显著高于接受肺叶切除术的患者（100%对79.3%，p = 0.044）。
对于直径小于2 cm、肿瘤消失率≥25%且最大标准化摄取值≤5.6的亚实性结节，可安全地进行肺段以下切除术。
