Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Professional Building, Suite 774, Chicago, IL, 60612, USA.
Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK.
Lung. 2021 Jun;199(3):311-318. doi: 10.1007/s00408-021-00447-5. Epub 2021 Apr 28.
Management of clinical stage IIIA-N2 (cIIIA-N2) non-small cell lung cancer (NSCLC) remains controversial. We evaluated treatment strategies and outcomes in cIIIA-N2 NSCLC patients who underwent pulmonary resection in The Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD) and the European Society of Thoracic Surgeons (ESTS) Registry.
The STS GTSD and ESTS Registry were queried for patients who underwent pulmonary resection for cIIIA-N2 NSCLC between 2012 and 2016. Demographic variables, treatment strategies, and outcome measures were collected and analyzed. Significance of differences was determined using the χ test for categorical variables and the Wilcoxon rank sum test for continuous variables.
Pulmonary resection was performed in 4279 cIIIA-N2 NSCLC patients (2928 STS GTSD; 1351 ESTS). Induction therapy was administered to 49%. Lobectomy was performed in 67.1% and pneumonectomy in 13%. Lobectomy was associated with 19.2% major morbidity and 1.6% operative mortality, while pneumonectomy was associated with 34.1% and 5%, respectively. Induction therapy was associated with a higher rate of major morbidity or mortality than upfront surgery (23.2% vs 19.5%, p = 0.004), driven by pneumonectomy (40.7% vs 30.3%, p = 0.012) rather than lobectomy (20.3% vs 18.8%, p = 0.31).
Pulmonary resection for cIIIA-N2 NSCLC is associated with low rates of operative morbidity and mortality, with lobectomy having lower morbidity and mortality than pneumonectomy. Induction therapy, particularly chemoradiotherapy, is associated with a higher rate of composite morbidity or mortality than upfront surgery in pneumonectomy patients but not lobectomy patients.
临床 IIIA-N2 期（cIIIA-N2）非小细胞肺癌（NSCLC）的治疗管理仍存在争议。我们评估了在胸外科医师学会普通胸外科数据库（STS GTSD）和欧洲胸外科医师学会（ESTS）注册中心接受肺切除术的 cIIIA-N2 NSCLC 患者的治疗策略和结局。
在 2012 年至 2016 年期间，STS GTSD 和 ESTS 注册中心对接受肺切除术治疗 cIIIA-N2 NSCLC 的患者进行了查询。收集并分析了人口统计学变量、治疗策略和结果测量。使用 χ2 检验用于分类变量，Wilcoxon 秩和检验用于连续变量来确定差异的显著性。
4279 例 cIIIA-N2 NSCLC 患者接受了肺切除术（2928 例 STS GTSD；1351 例 ESTS）。有 49%的患者接受了诱导治疗。行肺叶切除术的患者占 67.1%，行全肺切除术的患者占 13%。肺叶切除术的主要发病率为 19.2%，手术死亡率为 1.6%，而全肺切除术的主要发病率和手术死亡率分别为 34.1%和 5%。与直接手术相比，诱导治疗与更高的主要发病率或死亡率相关（23.2%比 19.5%，p=0.004），这主要是由于全肺切除术（40.7%比 30.3%，p=0.012）而不是肺叶切除术（20.3%比 18.8%，p=0.31）。
cIIIA-N2 NSCLC 行肺切除术的手术发病率和死亡率均较低，肺叶切除术的发病率和死亡率低于全肺切除术。与直接手术相比，诱导治疗（特别是放化疗）与全肺切除术患者的复合发病率或死亡率较高相关，但与肺叶切除术患者无关。
