Shen Jianfei, Zhuang Weitao, Xu Congcong, Jin Ke, Chen Baofu, Tian Dan, Hiley Crispin, Onishi Hiroshi, Zhu Chengchu, Qiao Guibin
Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China.
Department of Thoracic Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Front Surg. 2021 May 26;8:632561. doi: 10.3389/fsurg.2021.632561. eCollection 2021.
Timing for intervention of small indeterminate pulmonary nodules has long been a topic of debate given the low incidence of malignancy and difficulty in obtaining a definite preoperative diagnosis. We sought to determine survival outcomes of surgical and non-surgical managements in non-small cell lung cancer (NSCLC) ≤8 mm, which may provide a reference for prospective decision-making for patients with suspected NSCLC. A total of 1,652 patients with Stage IA NSCLC ≤8 mm were identified from the Surveillance, Epidemiology, and End Results (SEER) database and categorized into surgery and non-surgery groups. Chi-square test, -test and Mann-Whitney U test were used to compare the baseline characteristics between groups. Survival curves were depicted using Kaplan-Meier method and compared by log-rank test. Cox proportional hazard model was used for univariate and multivariate analyses. Adjustment of confounding factors between groups was performed by propensity score matching. The surgery and non-surgery groups included 1,438 and 208 patients, respectively. Patients in surgery group demonstrated superior survival outcome than patients in non-surgery group both before [overall survival (OS): HR, 16.22; 95% CI, 11.48-22.91, < 0.001; cancer-specific survival (CSS): HR, 49.6; 95% CI, 31.09-79.11, < 0.001] and after (OS: HR, 3.12; 95% CI, 2.40-4.05, < 0.001; CSS: HR, 3.85; 95% CI, 2.74-5.40, < 0.001) propensity score matching. The 30-day mortality rates were 3.1 and 12.0% in surgery and non-surgery groups, respectively. Multivariate analysis suggested age, sex, race, tumor size, grade, pathological stage were all independent prognostic factors in patients with ≤8 mm NSCLC. A comparison of surgical resections revealed a survival superiority of lobectomy over sub-lobectomy. In terms of CSS, no statistically significant difference was found between segmentectomy and wedge resection. The current SEER database showed better prognosis of surgical resection than non-surgical treatment in patients with ≤8 mm NSCLC. However, the factors that should be essentially included in the proper propensity-matched analysis, such as comorbidity, cardiopulmonary function and performance status were unavailable and the true superiority or inferiority should be examined further by ongoing randomized trial, especially comparing surgery and stereotactic body irradiation.
鉴于恶性肿瘤发生率低且术前难以获得明确诊断，小的不明确肺结节的干预时机长期以来一直是一个争论的话题。我们试图确定直径≤8mm的非小细胞肺癌（NSCLC）手术和非手术治疗的生存结果，这可能为疑似NSCLC患者的前瞻性决策提供参考。从监测、流行病学和最终结果（SEER）数据库中识别出总共1652例IA期直径≤8mm的NSCLC患者，并将其分为手术组和非手术组。采用卡方检验、t检验和曼-惠特尼U检验比较两组之间的基线特征。使用Kaplan-Meier方法绘制生存曲线，并通过对数秩检验进行比较。采用Cox比例风险模型进行单因素和多因素分析。通过倾向得分匹配对两组之间的混杂因素进行调整。手术组和非手术组分别包括1438例和208例患者。手术组患者在倾向得分匹配前[总生存（OS）：HR，16.22；95%CI，11.48 - 22.91，P < 0.001；癌症特异性生存（CSS）：HR，49.6；95%CI，31.09 - 79.11，P < 0.001]和匹配后（OS：HR，3.12；95%CI，2.40 - 4.05，P < 0.001；CSS：HR，3.85；95%CI，2.74 - 5.40，P < 0.001）的生存结果均优于非手术组。手术组和非手术组的30天死亡率分别为3.1%和12.0%。多因素分析表明，年龄、性别、种族、肿瘤大小、分级、病理分期都是直径≤8mm的NSCLC患者的独立预后因素。手术切除的比较显示肺叶切除术比肺叶下切除术具有生存优势。就CSS而言，肺段切除术和楔形切除术之间未发现统计学上的显著差异。当前的SEER数据库显示，直径≤8mm的NSCLC患者手术切除的预后优于非手术治疗。然而，适当的倾向得分匹配分析中应基本纳入的因素，如合并症、心肺功能和体能状态不可用，真正的优势或劣势应通过正在进行的随机试验进一步研究，特别是比较手术和立体定向体部放疗。
