Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Ann Surg. 2022 Dec 1;276(6):e1000-e1007. doi: 10.1097/SLA.0000000000004730. Epub 2021 Jan 7.
Although SABR is increasingly emerging as an alternative to surgery for node-negative non-small cell lung cancer, there is poor understanding of patients who may most benefit SABR compared to surgery.
This study examined the relationship between tumor size and the comparative outcomes of SABR and sublobar resection in patients with node-negative non-small cell lung cancer.
A total of 59,949 patients met study criteria: 19,888 (33%) underwent SABR, 33,052 (55%) wedge resection, and 7009 (12%) segmental resection. In multivariable regression, a significant 3-way interaction was found between histology, tumor size, and type of treatment. After stratification by histology, a significant interaction between tumor size and treatment was preserved for patients with adenocarcinoma and squamous cell carcinoma. Sublobar resection was associated with greater survival compared to SABR for tumor sizes greater than 6 and 8 mm for patients with adenocarcinoma and squamous cell carcinoma, respectively. SABR was associated with similar survival compared to sublobar resection for patients with papillary and large cell histology.
In this National Cancer Database analysis, sublobar resection was associated with greater survival compared to SABR for lesions >6or 8 mm in patients with adenocarcinoma or squamous cell carcinoma; however, SABR was associated with similar survival compared to sublobar resection in patients with aggressive tumors including papillary and large cell histology. Histologic diagnosis in patients with even small tumors may enable better treatment selection in those who cannot tolerate lobectomy.
虽然立体定向消融放疗（SABR）作为淋巴结阴性非小细胞肺癌的替代手术方法越来越受到关注，但对于与手术相比哪些患者可能从 SABR 中获益最大，人们对此知之甚少。
本研究探讨了淋巴结阴性非小细胞肺癌患者肿瘤大小与 SABR 和亚肺叶切除术比较结果之间的关系。
共有 59949 例患者符合研究标准：19888 例（33%）接受 SABR，33052 例（55%）行楔形切除术，7009 例（12%）行肺段切除术。多变量回归分析发现，组织学、肿瘤大小和治疗类型之间存在显著的三向交互作用。按组织学分层后，对于腺癌和鳞状细胞癌患者，肿瘤大小和治疗之间的显著交互作用仍然存在。对于腺癌和鳞状细胞癌患者，肿瘤大小大于 6mm 和 8mm 时，亚肺叶切除术的生存获益明显优于 SABR。SABR 与亚肺叶切除术的生存获益相似，适用于乳头状和大细胞组织学的患者。
在这项国家癌症数据库分析中，对于腺癌或鳞状细胞癌患者，肿瘤大小大于 6mm 或 8mm 时，亚肺叶切除术的生存获益明显优于 SABR；然而，对于侵袭性肿瘤（包括乳头状和大细胞组织学）患者，SABR 与亚肺叶切除术的生存获益相似。即使对于体积较小的肿瘤，组织学诊断也可以使那些不能耐受肺叶切除术的患者更好地选择治疗方法。
