Huang Weijia, Deng Han-Yu, Lin Ming-Ying, Xu Kai, Zhang Yu-Xiao, Yuan Chi, Zhou Qinghua
Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
West China School of Medicine, Sichuan University, Chengdu, China.
Front Oncol. 2022 Feb 18;12:830470. doi: 10.3389/fonc.2022.830470. eCollection 2022.
To compare the survival difference among lobectomy, segmentectomy, and wedge resection and investigate the role of adjuvant chemotherapy for early-stage small-sized non-small cell lung cancer (NSCLC) with visceral pleural invasion (VPI).
Patients diagnosed with stage IB peripheral NSCLC with VPI and ≤3 cm in size in the Surveillance, Epidemiology, and End Results database between 2004 and 2015 were included, and the pleural layer (PL) invasion status was identified to recognize the tumors with VPI, including PL1 and PL2. We conducted Cox proportional hazards model in multivariable analysis and subgroup analysis propensity score matching (PSM) method and Cox regression method to figure out the optimal therapy for these patients.
A total of 1,993 patients were included, all of whom received surgery, and the median follow-up was 33 months (range, 1-83 months). In multivariable analysis, age, gender, histology, pathological grade, lymph node examination, surgical approaches, and radiotherapy were independent prognostic factors for overall survival (OS). Lobectomy was superior to sublobar resection [hazard ratio (HR) = 1.41; 95% CI, 1.08-1.83], and wedge resection was associated with impaired survival compared to lobectomy (HR = 1.64; 95% CI, 1.22-2.20) in PSM analyses. In subgroup analysis, lobectomy was superior to sublobar resection among those aged <70 years (HR = 1.81; 95% CI, 1.13-2.90), female (HR = 1.75; 95% CI, 1.21-2.53), and 1-20 mm in size (HR = 1.61; 95% CI, 1.11-2.33). No survival benefit was observed for adjuvant chemotherapy.
Lobectomy was superior to wedge resection and comparable with segmentectomy for stage IB NSCLC (≤3 cm) with VPI, and adjuvant chemotherapy could not benefit these patients, even in those with sublobar resection. The preferred surgical procedure remains to be studied in prospective controlled trials.
比较肺叶切除术、肺段切除术和楔形切除术之间的生存差异，并探讨辅助化疗对伴有脏层胸膜侵犯（VPI）的早期小尺寸非小细胞肺癌（NSCLC）的作用。
纳入2004年至2015年监测、流行病学和最终结果数据库中诊断为IB期周围型NSCLC且伴有VPI且大小≤3 cm的患者，并确定胸膜层（PL）侵犯状态以识别伴有VPI的肿瘤，包括PL1和PL2。我们在多变量分析和亚组分析中采用倾向评分匹配（PSM）方法和Cox回归方法，以确定这些患者的最佳治疗方法。
共纳入1993例患者，所有患者均接受了手术，中位随访时间为33个月（范围1 - 83个月）。在多变量分析中，年龄、性别、组织学、病理分级、淋巴结检查、手术方式和放疗是总生存（OS）的独立预后因素。在PSM分析中，肺叶切除术优于肺段以下切除术[风险比（HR）= 1.41；95%置信区间（CI），1.08 - 1.83]，与肺叶切除术相比，楔形切除术与生存受损相关（HR = 1.64；95% CI，1.22 - 2.20）。在亚组分析中，在年龄<70岁者（HR = 1.81；95% CI，1.13 - 2.90）、女性（HR = 1.75；95% CI，1.21 - 2.53）和大小为1 - 20 mm者（HR = 1.61；95% CI，1.11 - 2.33）中，肺叶切除术优于肺段以下切除术。未观察到辅助化疗有生存获益。
对于伴有VPI的IB期NSCLC（≤3 cm），肺叶切除术优于楔形切除术，与肺段切除术相当，辅助化疗对这些患者无益处，即使是接受肺段以下切除术的患者。首选手术方式仍有待在前瞻性对照试验中进行研究。
