Ma Haibo, Cheng Jiwei, Yu Yongkui, Liu Baoxing, Qin Jianjun, Xing Wenqun, Luo Suxia
The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China.
The Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China.
J Thorac Dis. 2021 Jan;13(1):312-321. doi: 10.21037/jtd-20-3448.
Numerous retrospective studies have reported that sublobectomy has a poorer prognosis than lobectomy in patients with early-stage lung cancer. The purpose of this study was to determine whether adjuvant treatment could improve the prognosis of patients with non-small cell lung cancer (NSCLC) ≤3 cm after sublobectomy.
We collected data from 17,763 patients with T1N0M0 NSCLC after surgery from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. Kaplan-Meier curves were generated to compare the overall survival (OS) rates and the lung cancer-specific survival (LCSS) rates. Cox proportional hazards regressions were performed to discover the independent risk factors for both the OS and LCSS rates.
Lobectomy was performed in 12,428 cases and sublobectomy was performed in 5,335 cases. In the sublobectomy group, among the 394 patients treated with adjuvant therapy, larger tumor diameter, a lower number of lymph node dissections, and more wedge resections were observed in the patients treated with adjuvant therapy. In the subsequent survival analysis, the OS and LCSS rates of adjuvant therapy patients showed a significant survival advantage over those treated with sublobectomy alone (P<0.05). The survival analysis was performed again after propensity match scoring, generating similar results (P<0.05). There was still a significant difference in OS between adjuvant therapy and lobectomy alone (P<0.05).
Chemoradiotherapy can improve the OS of patients with NSCLC ≤3 cm after sublobectomy and reduce death caused by tumors. Therefore, when patients cannot tolerate lobectomy or are given inappropriate sublobectomy, adjuvant therapy can improve the prognosis of patients.
众多回顾性研究报告称，在早期肺癌患者中，亚肺叶切除术的预后比肺叶切除术差。本研究的目的是确定辅助治疗能否改善亚肺叶切除术后非小细胞肺癌（NSCLC）≤3 cm患者的预后。
我们从监测、流行病学和最终结果（SEER）数据库中收集了2004年至2015年间17763例T1N0M0 NSCLC术后患者的数据。绘制Kaplan-Meier曲线以比较总生存率（OS）和肺癌特异性生存率（LCSS）。进行Cox比例风险回归以发现OS和LCSS率的独立危险因素。
12428例患者接受了肺叶切除术，5335例患者接受了亚肺叶切除术。在亚肺叶切除术组中，在394例接受辅助治疗的患者中，接受辅助治疗的患者肿瘤直径更大、淋巴结清扫数量更少且楔形切除术更多。在随后的生存分析中，辅助治疗患者的OS和LCSS率显示出比单纯接受亚肺叶切除术的患者有显著的生存优势（P < 0.05）。在倾向匹配评分后再次进行生存分析，结果相似（P < 0.05）。辅助治疗与单纯肺叶切除术之间的OS仍有显著差异（P < 0.05）。
放化疗可改善亚肺叶切除术后NSCLC≤3 cm患者的OS，并降低肿瘤导致的死亡。因此，当患者无法耐受肺叶切除术或接受了不适当的亚肺叶切除术时，辅助治疗可改善患者的预后。
