Wang Weixi, Sun Yan, Li Huiting, Bao Minwei, Liu Xiaogang, Jiang Gening, Ye Cong, Hu Yu
Department of Geriatrics, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Respiratory, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
J Thorac Dis. 2020 Nov;12(11):6731-6742. doi: 10.21037/jtd-20-2221.
The appropriate surgical modality for early-stage non-small cell lung cancer (NSCLC) among the elderly remains controversial; identifying appropriate modalities will be helpful in clinical practice.
It's a cohort study and we explored the Surveillance, Epidemiology, and End Results (SEER) database for identifying patients aged ≥70 years with pathologic stage IA NSCLC. Three types of surgeries were compared (lobectomy, segmentectomy, and wedge resection) via survival and stratification analyses.
Overall, 6,197 patients were enrolled. Among patients aged ≥76 years with tumor diameters ≤1 cm, significant differences in survival were noted for segmentectomy lobectomy [hazard ratio (HR) =0.294, P=0.007] and wedge resection lobectomy (HR =0.548, P=0.017) but not in those with tumors diameters >1 cm. Among patients aged 70-75 years with tumor diameters >1-2 cm, significant differences in survival were observed for segmentectomy lobectomy (HR =0.671, P=0.037) and segmentectomy wedge resection (HR =0.556, P=0.003) and for wedge resection lobectomy (HR =1.283, P=0.003) among those with tumor diameters >2-3 cm but not in those with tumor diameters ≤1 cm.
Both age and tumor size should be considered when selecting the surgical modality. Lobectomy is not recommended for lesions ≤1 cm among patients aged ≥76 years. Segmentectomy was associated with superior prognosis for tumor diameters >1-2 cm and survival favored lobectomy rather than wedge resection for NSCLCs >2-3 cm among patients aged 70-75 years. Surgeons could rely on personal experience to determine the appropriate surgical modality for NSCLCs >1 cm among patients aged ≥76 years and NSCLCs ≤1 cm among patients aged 70-75 years.
老年早期非小细胞肺癌（NSCLC）的合适手术方式仍存在争议；确定合适的手术方式将有助于临床实践。
这是一项队列研究，我们通过监测、流行病学和最终结果（SEER）数据库来识别年龄≥70岁的病理分期为IA期NSCLC患者。通过生存分析和分层分析比较了三种手术类型（肺叶切除术、肺段切除术和楔形切除术）。
总体而言，共纳入6197例患者。在年龄≥76岁且肿瘤直径≤1 cm的患者中，肺段切除术与肺叶切除术相比生存有显著差异（风险比[HR]=0.294，P=0.007），楔形切除术与肺叶切除术相比也有显著差异（HR =0.548，P=0.017），但肿瘤直径>1 cm的患者中无此差异。在年龄70 - 75岁且肿瘤直径>1 - 2 cm的患者中，肺段切除术与肺叶切除术相比生存有显著差异（HR =0.671，P=0.037），肺段切除术与楔形切除术相比也有显著差异（HR =0.556，P=0.003）；在肿瘤直径>2 - 3 cm的患者中，楔形切除术与肺叶切除术相比有显著差异（HR =1.283，P=0.003），但肿瘤直径≤1 cm的患者中无此差异。
选择手术方式时应考虑年龄和肿瘤大小。对于年龄≥76岁且病变≤1 cm的患者，不建议行肺叶切除术。对于肿瘤直径>1 - 2 cm的患者，肺段切除术预后较好；对于年龄70 - 75岁且肿瘤直径>2 - 3 cm的NSCLC患者，肺叶切除术的生存效果优于楔形切除术。对于年龄≥76岁且肿瘤直径>1 cm的NSCLC患者以及年龄70 - 75岁且肿瘤直径≤1 cm的NSCLC患者，外科医生可根据个人经验确定合适的手术方式。
