Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.
Huai'an First People's Hospital, Nanjing Medical University, Huai'an, China.
Thorac Cancer. 2022 Jun;13(11):1664-1675. doi: 10.1111/1759-7714.14441. Epub 2022 May 5.
Sleeve lobectomy is recognized as an alternative surgical operation to pneumonectomy because it preserves the most pulmonary function and has a considerable prognosis. In this study, we aimed to investigate the implications of residual status for patients after sleeve lobectomy.
In this retrospective cohort study, we summarized 58 242 patients who underwent surgeries from 2015 to 2018 in Shanghai Chest Hospital and found 456 eligible patients meeting the criteria. The status of R2 was excluded. The outcomes were overall survival (OS) and recurrence-free survival (RFS). We performed a subgroup analysis to further our investigation.
After the propensity score match, the baseline characteristic was balanced between two groups. The survival analysis showed no significant difference of overall survival and recurrence-free survival between R0 and R1 groups (OS: p = 0.053; RFS: p = 0.14). In the multivariate Cox analysis, we found that the margin status was not a dependent risk factor to RFS (p = 0.119) and OS (p = 0.093). In the patients of R1, N stage and age were closely related to OS, but we did not find any significant risk variable in RFS for R1 status. In the subgroup analysis, R1 status may have a worse prognosis on patients with more lymph nodes examination. On further investigation, we demonstrated no differences among the four histological types of margin status.
In our study, we confirmed that the margin status after sleeve lobectomies was not the risk factor to prognosis. However, patients with more lymph nodes resection should pay attention to the margin status.
袖状肺叶切除术因能保留更多的肺功能且预后较好而被认为是全肺切除术的替代手术。本研究旨在探讨袖状肺叶切除术后患者残端状态的意义。
本回顾性队列研究汇总了 2015 年至 2018 年在上海胸科医院接受手术的 58242 例患者，发现符合条件的 456 例患者符合标准。排除 R2 状态。结果为总生存（OS）和无复发生存（RFS）。我们进行了亚组分析以进一步研究。
在倾向评分匹配后，两组的基线特征平衡。生存分析显示 R0 与 R1 组之间 OS 和 RFS 无显著差异（OS：p=0.053；RFS：p=0.14）。在多变量 Cox 分析中，我们发现切缘状态不是 RFS（p=0.119）和 OS（p=0.093）的独立危险因素。在 R1 患者中，N 分期和年龄与 OS 密切相关，但我们未发现 R1 状态对 RFS 的任何显著风险变量。在亚组分析中，R1 状态可能对接受更多淋巴结检查的患者预后更差。进一步研究表明，切缘状态在四种组织学类型中无差异。
在本研究中，我们证实袖状肺叶切除术后的切缘状态不是预后的危险因素。然而，切除更多淋巴结的患者应注意切缘状态。
