Department of Cardiothoracic Surgery, Hadassah Hebrew University Hospital, Jerusalem, Israel.
Cancer Rep (Hoboken). 2021 Jun;4(3):e1339. doi: 10.1002/cnr2.1339. Epub 2021 Feb 11.
The role of sub lobar resection (SLR; either segmentectomy or wedge resection) vs lobectomy (LBCT) for invasive clinical stage T1N0 non-small-cell-lung-cancer (NSCLC) has not been fully established yet.
We aimed to characterize the preoperative parameters leading to selecting SLR and compare the overall survival (OS) and disease-free survival (DFS) of these two surgical approaches.
Clinical data on 162 patients (LBCT-107; SLR-55) were prospectively entered in our departmental database. Preoperative parameters associated with the performance of SLR were identified using univariate and multivariate cox regression analysis. The Kaplan-Meier method was used to compute OS and DFS. Comparison between LBCT and SLR groups and 32 propensity-matched groups was performed using Log-rank test.
Median follow-up time for the LBCT and SLR groups was 4.76 (Inter-quartile range [IQR] 2.96 to 8.23) and 3.38 (IQR 2.9 to 6.19) years respectively. OS and DFS rates were similar between the two groups in the entire cohort (OS-LBCT vs SLR P = .853, DSF-LBCT vs SLR P = .653) and after propensity matching (OS-LBCT vs SLR P = .563 DSF-LBCT vs SLR P = .632). Specifically, Two- and five-year OS rates for LBCT and SLR were 90.6.% vs 92.7%, 71.8% vs 75.9% respectively. Independent predictors of selecting for SLR included older age (P < .001), reduced FEV1% (P = .026), smaller tumor size (P = .025), smaller invasive component (P = .021) and higher American Society of Anesthesiology scores (P = .014).
In 162 consecutive and 32 matched cases, SLR and lobar resection had similar overall and disease-free survival rates. SLR may be considered as a reasonable oncological procedure in carefully selected T1N0 NSCLC patients that present with multiple comorbidities and relatively small tumors.
亚肺叶切除术（SLR；包括节段切除术或楔形切除术）与肺叶切除术（LBCT）在浸润性临床 T1N0 非小细胞肺癌（NSCLC）中的作用尚未完全确定。
本研究旨在描述导致选择 SLR 的术前参数，并比较这两种手术方法的总生存（OS）和无病生存（DFS）。
前瞻性地将 162 例患者（LBCT-107 例；SLR-55 例）的临床资料录入我院数据库。采用单因素和多因素 Cox 回归分析确定与 SLR 相关的术前参数。采用 Kaplan-Meier 法计算 OS 和 DFS。采用 Log-rank 检验比较 LBCT 组和 SLR 组以及 32 个倾向评分匹配组之间的差异。
LBCT 组和 SLR 组的中位随访时间分别为 4.76（IQR 2.96-8.23）和 3.38（IQR 2.9-6.19）年。全队列中两组的 OS 和 DFS 率相似（OS-LBCT 与 SLR，P=0.853；DFS-LBCT 与 SLR，P=0.653），匹配后倾向评分后仍相似（OS-LBCT 与 SLR，P=0.563；DFS-LBCT 与 SLR，P=0.632）。LBCT 和 SLR 的 2 年和 5 年 OS 率分别为 90.6%和 92.7%，71.8%和 75.9%。选择 SLR 的独立预测因素包括年龄较大（P<0.001）、FEV1%较低（P=0.026）、肿瘤较小（P=0.025）、侵袭性成分较小（P=0.021）和美国麻醉医师协会评分较高（P=0.014）。
在 162 例连续病例和 32 例匹配病例中，SLR 和肺叶切除术的总生存和无病生存相似。对于有多种合并症且肿瘤相对较小的 T1N0 NSCLC 患者，SLR 可作为一种合理的肿瘤治疗方法。
