Février Esther, Yip Rowena, Becker Betsy J, Taioli Emanuela, Yankelevitz David F, Flores Raja, Henschke Claudia I, Schwartz Rebecca M
Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA.
Department of Educational Psychology and Learning Systems, College of Education, Florida State University, Tallahassee, FL, USA.
J Thorac Dis. 2020 Jul;12(7):3488-3499. doi: 10.21037/jtd-20-402.
Few studies have examined the differential impact of sublobar resection (SL) and lobectomy (L) on quality of life (QoL) during the first postoperative year.
We used a prospective cohort of Stage IA lung cancer patients undergoing video-assisted thoracoscopic surgery (VATS) from the Initiative for Early Lung Cancer Research on Treatment. QoL was measured before surgery, and within 4, 6, and 12 months post-surgery using three validated instruments: SF-12 [physical (PCS) and mental health (MCS)], FACT-LCS (lung-cancer-symptoms), and the PHQ-4 (anxiety and depression subscales). Locally weighted smoothing curve (LOWESS) was fitted to identify the best interval knot for the change in the QoL trend post-surgery. After adjusting for demographic and clinical variables, an adjusted piecewise linear mixed effects model was developed to estimate differences in baseline and 12-month scores, and rates of change for each QoL measure.
SL resection was performed in 127 (63.2%) and L in 74 (36.8%) patients. LOWESS plots suggested that the shift of QoL (interval knot) was at 2 months post-surgery. Decreases in PCS scores were less severe for SL than L patients 2 months post-surgery (-0.18 -2.30, P=0.02); while subsequent improvements were observed for both groups (SL: +0.29 L: +0.74, P=0.06). SL patients reported significantly better scores a year post-surgery compared to baseline (P=0.003), while L patients did not. Anxiety decreased at similar rates for both SL and L patients within 2 months post-surgery (P=0.18), then stabilized for the remaining months. MCS and depression scores remained stable in both groups throughout. QoL scores were lower for women than for men, but only significantly worse for the lung-cancer-symptoms (P=0.003) and anxiety (P=0.04).
SL patients fared better in physical health and lung cancer symptoms than L patients. The first two postoperative months showed the most significant change which suggests targeting postoperative intervention during that time.
很少有研究探讨亚肺叶切除术（SL）和肺叶切除术（L）对术后第一年生活质量（QoL）的不同影响。
我们使用了来自早期肺癌治疗研究倡议的接受电视辅助胸腔镜手术（VATS）的IA期肺癌患者的前瞻性队列。在手术前以及术后4、6和12个月使用三种经过验证的工具测量生活质量：SF-12[身体（PCS）和心理健康（MCS）]、FACT-LCS（肺癌症状）和PHQ-4（焦虑和抑郁子量表）。拟合局部加权平滑曲线（LOWESS）以确定术后生活质量趋势变化的最佳间隔节点。在调整人口统计学和临床变量后，建立了调整后的分段线性混合效应模型，以估计基线和12个月得分的差异以及每种生活质量测量的变化率。
127例（63.2%）患者接受了SL切除，74例（36.8%）患者接受了L切除。LOWESS图表明生活质量的变化（间隔节点）在术后2个月。术后2个月，SL患者的PCS得分下降程度低于L患者（-0.18对-2.30，P=0.02）；而随后两组均观察到改善（SL：+0.29对L：+0.74，P=0.06）。与基线相比，SL患者术后一年的得分显著更高（P=0.003），而L患者则没有。术后2个月内，SL和L患者的焦虑以相似的速率下降（P=0.18），然后在其余月份保持稳定。两组的MCS和抑郁得分在整个过程中保持稳定。女性的生活质量得分低于男性，但仅在肺癌症状（P=0.003）和焦虑（P=0.04）方面显著更差。
SL患者在身体健康和肺癌症状方面比L患者表现更好。术后的前两个月显示出最显著的变化，这表明在此期间针对术后干预。
