Division of Thoracic Surgery, Rudy L Ruggles Biomedical Research Institute, Nuvance Health Systems, Danbury, CT, USA.
Division of Thoracic Surgery, Memorial Healthcare System, South Broward, FL, USA.
Eur J Cardiothorac Surg. 2021 May 8;59(5):1014-1020. doi: 10.1093/ejcts/ezaa443.
The extent of surgical resection for early-stage second primary lung cancer (SPLC) in patients with a previous lobectomy is unclear. We sought to compare anatomic lung resections (lobectomy and segmentectomy) and wedge resections for small peripheral SPLC using a population-based database.
The Surveillance, Epidemiology and End Results database was queried for all patients with ≤2 cm peripheral SPLC diagnosed between 2004 and 2015 who underwent prior lobectomy for the first primary and surgical resection only for the SPLC. American College of Chest Physicians guidelines were used to classify SPLC. Kaplan-Meier analysis and multivariable Cox regression were used to compare overall survival.
A total of 356 patients met the inclusion criteria with 203 (57%) treated with wedge resection and 153 (43%) treated with anatomic resection. Significantly better median survival was observed with anatomic resection than with wedge resection using a Kaplan-Meier analysis (124 vs 63 months; P < 0.001). With multivariable Cox regression, improved long-term survival was observed for anatomic resection (hazard ratio: 0.44, confidence interval: 0.27-0.70; P = 0.001). Improvement in survival was demonstrated with wedge resection when lymph node sampling was done. Lastly, we calculated the average treatment effect on the treated with inverse probability weighting for a subgroup of patients and found that those with wedge resection and lymph node sampling had shorter long-term survival times.
Anatomic resections may provide better long-term survival than wedge resections for patients with early-stage peripheral SPLC after prior lobectomy. Significant improvement in survival was observed with wedge resection for SPLC when adequate lymph node dissection was performed.
对于先前接受过肺叶切除术的早期第二原发性肺癌（SPLC）患者，其手术切除范围尚不清楚。我们试图使用基于人群的数据库比较解剖性肺切除术（肺叶切除术和节段切除术）和楔形切除术治疗小周边 SPLC。
从 2004 年至 2015 年期间，在诊断出≤2cm 外周 SPLC 的所有先前接受过第一原发性肺叶切除术且仅接受 SPLC 手术切除的患者中，对 Surveillance，Epidemiology and End Results 数据库进行了查询。美国胸科医师学会指南用于分类 SPLC。采用 Kaplan-Meier 分析和多变量 Cox 回归比较总生存期。
共有 356 名患者符合纳入标准，其中 203 名（57%）接受楔形切除术，153 名（43%）接受解剖性切除术。Kaplan-Meier 分析显示，解剖性切除术的中位生存期明显长于楔形切除术（124 与 63 个月；P<0.001）。多变量 Cox 回归显示，解剖性切除术与长期生存改善相关（风险比：0.44，置信区间：0.27-0.70；P=0.001）。当进行淋巴结采样时，楔形切除术的生存改善得以证明。最后，我们通过逆概率加权法为亚组患者计算了平均处理效果，发现接受楔形切除术和淋巴结采样的患者长期生存时间更短。
对于先前接受过肺叶切除术的早期外周 SPLC 患者，解剖性切除术可能比楔形切除术提供更好的长期生存。当充分进行淋巴结清扫时，楔形切除术对 SPLC 的生存改善明显。
