Huang Weijia, Deng Han-Yu, Wu Xiao-Na, Xu Kai, Li Peiwei, Lin Ming-Ying, Yuan Chi, Zhou Qinghua
Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, PR China.
Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, PR China.
Asian J Surg. 2023 Jan;46(1):385-393. doi: 10.1016/j.asjsur.2022.04.078. Epub 2022 May 5.
With the increasing incidence of stage IA lung cancer ≤1 cm in size, the optimal primary treatment remains to be controversial, and thus, we compared the survival of these patients treated with radiotherapy, wedge resection, segmentectomy, or lobectomy in a large population.
We identified patients with stage IA lung cancer ≤1 cm in size between 2004 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database. We compared the overall survival (OS) via Kaplan-Meier analysis and conducted Cox regression analysis via propensity score matching (PSM) method to identify the relative hazard ratio (HR) and difference of OS among these treatments in the subgroup stratified by four variables (age, total number of tumors, pathological grade, and histology).
A total of 5435 patients were included with a median age of 68 years (range, 6-94 years), of which 2131 (39.2%) were male, and 3510 (64.6%) were adenocarcinoma. The 5-year OS rate was 67.1%, 34.5%, 61.6%, 72.1%, and 75.0% for the entire study population, radiotherapy, wedge resection, segmentectomy, and lobectomy, respectively. In PSM analysis, wedge resection and segmentectomy were all superior to radiotherapy (P < 0.001), and segmentectomy was superior to wedge resection (P = 0.043), while segmentectomy was comparable with lobectomy (P = 0.058). In patients with multiple tumors, radiotherapy brought similar survival to surgery (wedge resection versus radiotherapy, P = 0.323; segmentectomy versus radiotherapy, P = 0.170; lobectomy versus radiotherapy, P = 0.796).
Among stage IA lung cancer with ≤1 cm, segmentectomy and lobectomy were identified as the potential effective treatments, with segmentectomy more preferred, while radiotherapy would be recommended in those with multiple tumors, which requires further verification.
随着直径≤1 cm的IA期肺癌发病率不断上升，最佳的初始治疗方案仍存在争议，因此，我们在一大群患者中比较了接受放射治疗、楔形切除术、肺段切除术或肺叶切除术的这些患者的生存率。
我们在监测、流行病学和最终结果（SEER）数据库中确定了2004年至2015年间直径≤1 cm的IA期肺癌患者。我们通过Kaplan-Meier分析比较总生存期（OS），并通过倾向评分匹配（PSM）方法进行Cox回归分析，以确定在按四个变量（年龄、肿瘤总数、病理分级和组织学）分层的亚组中这些治疗方法之间的相对风险比（HR）和OS差异。
共纳入5435例患者，中位年龄68岁（范围6 - 94岁），其中男性2131例（39.2%），腺癌3510例（64.6%）。整个研究人群、放射治疗、楔形切除术、肺段切除术和肺叶切除术的5年OS率分别为67.1%、34.5%、61.6%、72.1%和75.0%。在PSM分析中，楔形切除术和肺段切除术均优于放射治疗（P < 0.001），肺段切除术优于楔形切除术（P = 0.043），而肺段切除术与肺叶切除术相当（P = 0.058）。在多原发肿瘤患者中，放射治疗与手术的生存率相似（楔形切除术与放射治疗，P = 0.323；肺段切除术与放射治疗，P = 0.170；肺叶切除术与放射治疗，P = 0.796）。
在直径≤1 cm的IA期肺癌中，肺段切除术和肺叶切除术被确定为潜在的有效治疗方法，更倾向于肺段切除术，而对于多原发肿瘤患者建议采用放射治疗，这需要进一步验证。
