Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
Department of Surgery, Tokyo Medical University, Tokyo, Japan.
Clin Lung Cancer. 2022 Jul;23(5):393-401. doi: 10.1016/j.cllc.2021.10.005. Epub 2022 Apr 27.
Although sublobar resection is widely used for lung cancer treatment, very limited data are available comparing outcomes after complex segmentectomy and wedge resection. We compared the oncological outcomes of complex segmentectomy and wedge resection for clinical stage 0-IA lung cancer via a large cohort, multicenter database using propensity score-matched analysis.
We retrospectively analyzed data from 506 clinical stage 0-IA, solid component size ≤ 2.0 cm lung cancer patients who underwent surgical resection at three institutions between 2010 and 2018. Surgical results after complex segmentectomy (n = 222) and "location-adjusted" wedge resection (n = 284) were analyzed for all patients and their propensity score-matched pairs.
In all cohort, the complex segmentectomy group tended to have a better prognosis than the wedge resection group (5 year cancer-specific survival rate, 97.4% vs. 93.7%; P = .065 and 5 year recurrence-free interval [RFI] rates, 96.9% vs. 86.1%; P = .0005). This trend was also identified in subanalyses for pure solid tumors. In 179 propensity score-matched pairs, the prognosis of patients with complex segmentectomy tended to be better than that of patients with wedge resection (5 year cancer-specific survival rates, 96.8% vs. 92.9%; 5 year RFI rates, 96.3% vs. 87.5%). Multivariable Cox regression analysis for RFI revealed that complex segmentectomy significantly reduced lung cancer recurrence compared with wedge resection (hazard ratio, 0.32; 95% confidence interval, 0.12-0.73; P = .0061).
Complex segmentectomy can provide better oncological outcomes compared with wedge resection.
虽然亚肺叶切除术被广泛用于肺癌的治疗，但比较复杂节段切除术和楔形切除术术后结果的资料非常有限。我们通过大样本、多中心数据库，采用倾向性评分匹配分析，比较了临床 I 期 0 期肺癌患者行复杂节段切除术和楔形切除术的肿瘤学结果。
我们回顾性分析了 2010 年至 2018 年在三个机构接受手术治疗的 506 例临床 I 期 0 期、实性成分大小≤2.0cm 肺癌患者的数据。分析了所有患者和他们的倾向性评分匹配对的复杂节段切除术（n=222）和“位置调整”楔形切除术（n=284）的手术结果。
在所有队列中，复杂节段切除术组的预后优于楔形切除术组（5 年癌症特异性生存率，97.4% vs. 93.7%；P=0.065 和 5 年无复发生存率[RFI]，96.9% vs. 86.1%；P=0.0005）。在纯实体肿瘤的亚分析中也发现了这一趋势。在 179 对倾向性评分匹配对中，复杂节段切除术患者的预后优于楔形切除术患者（5 年癌症特异性生存率，96.8% vs. 92.9%；5 年 RFI 率，96.3% vs. 87.5%）。RFI 的多变量 Cox 回归分析显示，与楔形切除术相比，复杂节段切除术显著降低了肺癌复发率（风险比，0.32；95%置信区间，0.12-0.73；P=0.0061）。
与楔形切除术相比，复杂节段切除术可提供更好的肿瘤学结果。
