Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
J Thorac Cardiovasc Surg. 2021 Oct;162(4):1244-1252.e1. doi: 10.1016/j.jtcvs.2020.10.024. Epub 2020 Oct 22.
The study objective was to compare cancer control between segmentectomy and wedge resection in patients with clinical stage IA non-small cell lung cancer.
Between 2010 and 2015, 457 patients with clinical stage IA (8th edition) non-small cell lung cancer undergoing wedge resection or segmentectomy were identified at 3 institutions. Propensity scores were calculated on the basis of the extent of resection (wedge resection or segmentectomy) and included adjustment for confounding variables, such as age, sex, smoking status, pulmonary functions, laterality, tumor size, maximum standardized uptake value on F-fluorodeoxyglucose positron emission tomography, presence of ground-glass opacity on high-resolution computed tomography, histology, and visceral pleural invasion for multivariable analysis and matching. The primary end point was cumulative incidence of recurrence.
In all cohorts, postoperative recurrence occurred in 36 of 195 patients (18.5%) undergoing wedge resection and 14 of 262 patients (5.3%) undergoing segmentectomy. Cumulative incidence of recurrence was significantly lower in patients undergoing segmentectomy (5-year cumulative incidence of recurrence, 5.3%) than in those undergoing wedge resection (5-year cumulative incidence of recurrence, 19.1%; P < .001). In propensity score-adjusted multivariable analysis, segmentectomy was identified as an independent favorable prognostic factor for cumulative incidence of recurrence (hazard ratio, 0.47; 95% confidence interval, 0.24-0.90; P = .022). In propensity score matching of 163 pairs, cumulative incidence of recurrence was significantly lower in patients undergoing segmentectomy (5-year cumulative incidence of recurrence, 6.6%) than in those undergoing wedge resection (5-year cumulative incidence of recurrence, 13.2%; P = .041).
Cancer control was better in segmentectomy than in wedge resection. Segmentectomy is the preferred oncologic procedure as sublobar resection to treat clinical stage IA non-small cell lung cancer.
本研究旨在比较临床ⅠA 期非小细胞肺癌患者行解剖性肺段切除术与楔形切除术的肿瘤控制效果。
在 3 家医疗机构中，我们于 2010 年至 2015 年间共纳入了 457 例接受楔形切除术或解剖性肺段切除术的临床ⅠA（第 8 版）期非小细胞肺癌患者。根据切除范围（楔形切除术或解剖性肺段切除术）计算倾向评分，并进行多变量分析和匹配，调整混杂变量，如年龄、性别、吸烟状态、肺功能、病变侧别、肿瘤大小、氟-18 氟代脱氧葡萄糖正电子发射断层扫描最大标准化摄取值、高分辨率计算机断层扫描的磨玻璃密度影、组织学和脏层胸膜侵犯。主要终点为复发累积发生率。
在所有队列中，行楔形切除术的 195 例患者中有 36 例（18.5%）和行解剖性肺段切除术的 262 例患者中有 14 例（5.3%）发生术后复发。行解剖性肺段切除术患者的复发累积发生率明显低于行楔形切除术患者（5 年复发累积发生率，5.3%比 19.1%；P<0.001）。在倾向评分调整后的多变量分析中，解剖性肺段切除术被确定为复发累积发生率的独立预后良好因素（风险比，0.47；95%置信区间，0.24-0.90；P=0.022）。在行 163 对倾向评分匹配后，行解剖性肺段切除术患者的复发累积发生率明显低于行楔形切除术患者（5 年复发累积发生率，6.6%比 13.2%；P=0.041）。
解剖性肺段切除术的肿瘤控制效果优于楔形切除术。解剖性肺段切除术是治疗临床ⅠA 期非小细胞肺癌的首选亚肺叶切除术式。
