Department of Thoracic Surgery, Nanjing Chest Hospital, Nanjing, China.
Department of Thoracic Surgery, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.
Thorac Cancer. 2021 May;12(10):1589-1597. doi: 10.1111/1759-7714.13955. Epub 2021 Apr 1.
This study aimed to investigate the prognostic impact of intrapulmonary lymph node (ILN, stations 13-14) dissection on disease-free survival (DFS) in stage IA non-small cell lung cancer (NSCLC) patients in order to facilitate a more suitable determination of surgical strategies for early-stage cases.
We retrospectively analyzed 416 patients with pathological stage IA NSCLC from February 2016 to November 2019. The patients were divided into a group with ILN dissection (ILN group) and a group without ILN dissection (ILN group). DFS was compared using the Kaplan-Meier method and compared statistically using the log-rank test before and after propensity score matching (PSM). Subgroup analysis of DFS stratified based on tumor size was also calculated.
Both before and after PSM, the four-year DFS of the ILN group was greatly increased compared to that of ILN group (90.1% vs. 79.7%, p = 0.003; 95.5% vs. 80.6%, p = 0.003, respectively) and multivariable cox regression analysis revealed ILN dissection was an independent factor favoring DFS in stage IA NSCLC (p = 0.016 and p = 0.015, respectively). Subgroup analysis revealed the four-year DFS was comparable between the ILN and ILN groups with regard to tumor size ≤1.5 cm (90.6% vs. 92.7%, p = 0.715). However, the ILN group was found to have a better oncological outcome compared with the ILN group with regard to tumor size >1.5 cm (90.0% vs. 73.8%, p = 0.003).
The prognostic impact of ILN dissection on patients with stage IA NSCLC appears to be significantly influenced by tumor size, and this should be taken into account when choosing the most appropriate therapeutic modality.
本研究旨在探讨在ⅠA 期非小细胞肺癌（NSCLC）患者中进行肺内淋巴结（stations 13-14，简称 ILN）清扫对无病生存（DFS）的预后影响，以便为早期病例制定更合适的手术策略。
我们回顾性分析了 2016 年 2 月至 2019 年 11 月期间的 416 例病理分期为ⅠA 期 NSCLC 患者。将患者分为行 ILN 清扫（ILN 组）和未行 ILN 清扫（ILN 组）两组。采用 Kaplan-Meier 法比较两组患者的 DFS，并用对数秩检验比较倾向性评分匹配（PSM）前后的差异。同时还对基于肿瘤大小的 DFS 进行了亚组分析。
PSM 前后，ILN 组的四年 DFS 均明显高于 ILN 组（90.1% vs. 79.7%，p = 0.003；95.5% vs. 80.6%，p = 0.003），多变量 Cox 回归分析表明，ILN 清扫是影响ⅠA 期 NSCLC 患者 DFS 的独立因素（p = 0.016 和 p = 0.015）。亚组分析显示，对于肿瘤大小≤1.5cm 的患者，ILN 组和 ILN 组的四年 DFS 无显著差异（90.6% vs. 92.7%，p = 0.715）。然而，对于肿瘤大小>1.5cm 的患者，ILN 组的肿瘤学预后明显优于 ILN 组（90.0% vs. 73.8%，p = 0.003）。
ILN 清扫对ⅠA 期 NSCLC 患者的预后影响似乎受肿瘤大小显著影响，在选择最合适的治疗方式时应考虑这一点。
