Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Youyi No 1 Road, Yuzhong, Chongqing, 400016, People's Republic of China.
Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Youyi No 1 Road, Yuzhong, Chongqing, 400016, People's Republic of China.
Aging Clin Exp Res. 2022 Aug;34(8):1925-1934. doi: 10.1007/s40520-022-02112-0. Epub 2022 Mar 28.
The optimal extent of surgery for older patients with early-stage pulmonary carcinoid tumour (PC) remains controversial.
To compare prognostic differences between sublobar resection versus lobectomy in older patients with early-stage PC.
The SEER database was searched for stage T1N0M0 PC patients aged ≥ 65 years who underwent lobectomy or sublobar resection from 2000 to 2017. Propensity score matching (PSM) was used to determine intergroup covariate differences. Kaplan-Meier curves and the log-rank test were used for intergroup comparison of overall survival (OS). A Cox proportional hazard model was used to evaluate independent risk factors.
Among 1023 participants, 650 and 373 underwent lobectomy and sublobar resection, respectively. Before PSM, the 5- and 10-year OS in the sublobar resection group were lower than that of the lobectomy group (5-year OS 84.12% vs. 91.16%; 10-year OS 57.43% vs. 64.77%; p = 0.014); after PSM, no significant prognostic difference existed between lobectomy and sublobar resection (5-year OS 88.17% vs. 89.23%; 10-year OS 58.32% vs. 62.75%; p = 0.811). Subgroup analysis included tumour size, age, number of lymph nodes examined and histological type, and showed no statistically significant survival differences between the lobectomy and sublobar resection groups. Multivariable Cox analysis indicated that age ≥ 77 years, male sex, inadequate lymph node assessment (< 7), and atypical carcinoid were associated with reduced OS.
Sublobar resection showed a similar long-term survival rate for early-stage PC patients aged ≥ 65 years as with lobectomy, thereby providing a basis for the selection of surgical methods for PC.
对于早期肺类癌瘤（PC）的老年患者，手术的最佳范围仍存在争议。
比较亚肺叶切除术与肺叶切除术治疗早期 PC 老年患者的预后差异。
从 2000 年至 2017 年，在 SEER 数据库中搜索接受亚肺叶切除术或肺叶切除术的年龄≥65 岁、分期为 T1N0M0PC 的患者。采用倾向评分匹配（PSM）来确定组间协变量差异。使用 Kaplan-Meier 曲线和对数秩检验比较总生存期（OS）的组间差异。采用 Cox 比例风险模型评估独立的危险因素。
在 1023 名参与者中，650 名患者接受了肺叶切除术，373 名患者接受了亚肺叶切除术。在 PSM 之前，亚肺叶切除术组的 5 年和 10 年 OS 均低于肺叶切除术组（5 年 OS 84.12% vs. 91.16%；10 年 OS 57.43% vs. 64.77%；p=0.014）；PSM 后，肺叶切除术和亚肺叶切除术之间的预后差异无统计学意义（5 年 OS 88.17% vs. 89.23%；10 年 OS 58.32% vs. 62.75%；p=0.811）。亚组分析包括肿瘤大小、年龄、检查的淋巴结数量和组织学类型，两组之间的生存差异无统计学意义。多变量 Cox 分析表明，年龄≥77 岁、男性、淋巴结评估不足（<7 个）和非典型类癌与 OS 降低相关。
对于年龄≥65 岁的早期 PC 患者，亚肺叶切除术与肺叶切除术的长期生存率相似，为 PC 手术方法的选择提供了依据。
