Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Lung Cancer. 2021 Feb;152:78-85. doi: 10.1016/j.lungcan.2020.12.017. Epub 2020 Dec 20.
In early stage non-small cell lung cancer, the optimal surgical approach for lymph node dissection remains controversial. Without a uniform standard for the quality of lymph node dissection, outcomes of nodal upstaging comparing video-assisted thoracoscopic surgery (VATS) versus open thoracotomy (OPEN) also remain controversial. Thus, we compared the clinical outcomes of nodal upstaging between each approach.
We retrospectively evaluated 1319 surgically resected lung cancer cases between 2008 and 2017 at our institute. Moreover, 348 VATS and 348 OPEN cases were extracted using propensity score matching. We investigated the frequency, prognosis, and post-recurrence course of nodal upstaging between each approach.
A total of 193 nodal upstaging cases were identified. Nodal upstaging was more frequent in the OPEN group (24 %) than the VATS group (9%) (p < 0.001). However, multivariable analysis revealed the surgical approach was not significantly associated with nodal upstaging (OPEN: odds ratio, 1.3; 95 % confidence interval, 0.93-2.02; p = 0.108) and, after matching, nodal upstaging with each approach were of equivalent frequency (p = 0.752). The median follow-up period was 5.0 years. Nodal upstaging was an independent prognostic factor for worse overall survival, cancer-specific survival, and recurrence-free survival in multivariable analyses (all p < 0.001). Of all cases, 222 recurred after surgery. There were no significant differences in recurrence patterns and initial recurrence sites depending on surgical approach. The 5-year post-recurrence survival rate was 52 % after VATS and 30 % after OPEN; however, this difference was not statistically significant (p = 0.052). Moreover, post-recurrence survival rate was not significantly different between the VATS and OPEN groups (pN0: p = 0.268, pN1: p = 0.437, and pN2: p = 0.144).
Outcomes of nodal upstaging between VATS and OPEN were found to be equivalent. The difference in the frequency of nodal upstaging was not due to inferior quality of lymph node dissection with VATS; rather, that difference resulted from selection bias.
在早期非小细胞肺癌中，对于淋巴结清扫的最佳手术方法仍存在争议。由于没有统一的淋巴结清扫质量标准，因此比较电视辅助胸腔镜手术（VATS）与开胸手术（OPEN）之间的淋巴结分期升级结果也存在争议。因此，我们比较了两种方法之间的淋巴结分期升级的临床结果。
我们回顾性评估了 2008 年至 2017 年在我院接受手术治疗的 1319 例肺癌病例。此外，使用倾向评分匹配法提取了 348 例 VATS 和 348 例 OPEN 病例。我们研究了两种方法之间淋巴结分期升级的频率、预后和复发后过程。
共发现 193 例淋巴结分期升级病例。OPEN 组（24%）比 VATS 组（9%）的淋巴结分期升级更常见（p<0.001）。然而，多变量分析显示手术方法与淋巴结分期升级无显著相关性（OPEN：比值比，1.3；95%置信区间，0.93-2.02；p=0.108），并且在匹配后，两种方法的淋巴结分期升级频率相当（p=0.752）。中位随访时间为 5.0 年。淋巴结分期升级是多变量分析中总生存、癌症特异性生存和无复发生存的独立预后因素（均 p<0.001）。所有病例中，222 例在手术后复发。根据手术方法，复发模式和初始复发部位没有显著差异。VATS 后 5 年的复发后生存率为 52%，OPEN 后为 30%；然而，这一差异没有统计学意义（p=0.052）。此外，VATS 和 OPEN 组之间的复发后生存率无显著差异（pN0：p=0.268，pN1：p=0.437，pN2：p=0.144）。
VATS 和 OPEN 之间的淋巴结分期升级结果相当。VATS 淋巴结清扫质量并不差，导致淋巴结分期升级频率差异的原因不是手术方法，而是选择偏倚。
