Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Radiology and Research Institute of Radiology, Asan Medical center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Thorac Cancer. 2021 Mar;12(6):941-948. doi: 10.1111/1759-7714.13876. Epub 2021 Feb 7.
Ongoing studies are currently investigating the extent of surgical resection required for subsolid cancers. This study aimed to investigate the predictive factors related to recurrence in patients with clinical stage IA subsolid cancer who underwent either lobectomy or sublobar resection.
This was a prospective multicenter observational study conducted in eight qualifying university teaching hospitals between April 2014 and December 2016. A total of 173 patients with subsolid nodules pathologically confirmed to have primary lung adenocarcinoma and stage IA disease were included in the final analysis. All patients underwent lobectomy, segmentectomy, or wedge resection performed by experienced thoracoscopic surgeons at each site. The surgical procedure was chosen based on the decision of the surgeons involved. The primary endpoint was time to recurrence (TTR).
The study population was 43.9% (76 of 173) male with a mean age of 60.7 years. During the median follow-up period of 5.01 years, nine patients (5%) experienced disease recurrence. In the multivariable analysis, tumor size (size ≥2 cm) (hazard ratio: 73.717, 95% confidence interval [CI]: 3.635-895.036; p < 0.001) and stage IA3 (hazard ratio: 62.010, 95% CI: 2.837-855.185; p < 0.001) were independent predictors of tumor recurrence. When analyzing the recurrence outcome in patients according to surgical procedure, no significant difference was found in TTR among the three groups (i.e., lobectomy, segmentectomy, and wedge resection; p = 0.99).
Patients with radiologically subsolid lung adenocarcinoma measuring <3 cm could be candidates for sublobar resection instead of lobectomy.
目前正在进行的研究正在探讨实性和亚实性肺癌的手术切除范围。本研究旨在探讨临床 I 期亚实性肺癌患者行肺叶切除术或亚肺叶切除术的复发相关预测因素。
这是一项于 2014 年 4 月至 2016 年 12 月在 8 家有资格的大学教学医院进行的前瞻性多中心观察性研究。共有 173 例经病理证实为原发性肺腺癌和 I 期疾病的亚实性结节患者纳入最终分析。所有患者均在各中心由经验丰富的胸腔镜外科医生行肺叶切除术、节段切除术或楔形切除术。手术方式由参与手术的外科医生决定。主要终点是复发时间（TTR）。
研究人群中 43.9%（76/173）为男性，平均年龄为 60.7 岁。在中位随访 5.01 年期间，9 例（5%）患者发生疾病复发。多变量分析显示，肿瘤大小（≥2cm）（危险比：73.717，95%置信区间[CI]：3.635-895.036；p<0.001）和 IA3 期（危险比：62.010，95% CI：2.837-855.185；p<0.001）是肿瘤复发的独立预测因素。在根据手术方式分析患者的复发结局时，三组之间的 TTR 无显著差异（即肺叶切除术、节段切除术和楔形切除术；p=0.99）。
对于影像学表现为<3cm 的肺腺癌患者，可以选择亚肺叶切除术而不是肺叶切除术。
