Yu Xiangyang, Zhang Rusi, Zhang Mengqi, Lin Yongbin, Zhang Xuewen, Wen Yingsheng, Yang Longjun, Huang Zirui, Wang Gongming, Zhao Dechang, Gonzalez Michel, Baste Jean-Marc, Petersen Rene Horsleben, Ng Calvin S H, Brunelli Alessandro, Zheng Lie, Zhang Lanjun
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.
Department of Pathology, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, China.
Transl Lung Cancer Res. 2021 Feb;10(2):900-913. doi: 10.21037/tlcr-20-1217.
The feasibility of segmental resection for early-stage non-small cell lung cancer (NSCLC) is still controversial. This study aimed to compare survival outcomes following lobectomy and segmental resection in patients with pathological T1cN0M0 (tumor size 21-30 mm) NSCLC.
Patients diagnosed between 1998 and 2016 with pathological stage IA NSCLC and with tumors measuring 21-30 mm were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The observational outcomes were cancer-specific survival (CSS) and overall survival (OS) at 5 years. Univariate survival analysis was carried out to identify potential prognostic factors of prolonged survival. Cox proportional hazards model was used to adjust for confounding factors. Additionally, pairwise comparisons were conducted between lobectomy and segmental resection for CSS and OS, and forest plots were drawn.
Of the 9,580 patients analyzed, 400 patients (4.2%) underwent segmental resections. Patients with older age (P<0.001), smaller tumors (P<0.001), and left-sided tumors (P=0.002) were more likely to receive segmental resection. No difference was found in the operative mortality rates between the segmental resection group and the lobectomy group (1.0% . 1.2%, P=0.707). The CSS (HR, 1.429; 95% CI, 1.166-1.752; P=0.001) and OS (HR, 1.348; 95% CI, 1.176-1.544; P<0.001) in the segmental resection group were significantly worse than those in the lobectomy group. Subgroup analyses by age, year of diagnosis, sex, tumor size, histology, grade, and the number of dissected lymph nodes also confirmed that lobectomy was associated with improved CSS and OS.
Lobectomy and thorough removal of lymph nodes should continue to be the recommended standard of care for patients with surgically resectable stage IA NSCLC with tumor size of 21-30 mm.
早期非小细胞肺癌（NSCLC）节段性切除的可行性仍存在争议。本研究旨在比较病理T1cN0M0（肿瘤大小21 - 30 mm）的NSCLC患者肺叶切除术和节段性切除术后的生存结果。
从监测、流行病学和最终结果（SEER）数据库中提取1998年至2016年诊断为病理IA期NSCLC且肿瘤大小为21 - 30 mm的患者。观察结果为5年时的癌症特异性生存（CSS）和总生存（OS）。进行单因素生存分析以确定延长生存的潜在预后因素。使用Cox比例风险模型调整混杂因素。此外，对肺叶切除术和节段性切除术的CSS和OS进行成对比较，并绘制森林图。
在分析的9580例患者中，400例患者（4.2%）接受了节段性切除。年龄较大（P<0.001）、肿瘤较小（P<0.001）和左侧肿瘤（P = 0.002）的患者更有可能接受节段性切除。节段性切除组和肺叶切除组的手术死亡率无差异（1.0% 对1.2%，P = 0.707）。节段性切除组的CSS（HR，1.429；95% CI，1.166 - 1.752；P = 0.001）和OS（HR，1.348；95% CI，1.176 - 1.544；P<0.001）明显低于肺叶切除组。按年龄、诊断年份、性别、肿瘤大小、组织学、分级和清扫淋巴结数量进行的亚组分析也证实，肺叶切除术与改善的CSS和OS相关。
对于肿瘤大小为21 - 30 mm的可手术切除的IA期NSCLC患者，肺叶切除术和彻底清除淋巴结仍应是推荐的标准治疗方法。
