Merritt Robert E, Abdel-Rasoul Mahmoud, D'Souza Desmond M, Kneuertz Peter J
Department of Surgery, Thoracic Surgery Division, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Center for Biostatistics, The Ohio State University, Columbus, Ohio.
Ann Thorac Surg. 2023 Jan;115(1):175-182. doi: 10.1016/j.athoracsur.2022.05.041. Epub 2022 Jun 14.
There may be equivalent efficacy of the lymph node evaluation for minimally invasive lobectomy compared with open lobectomy for stage I non-small cell lung cancer. We sought to compare the lymph node evaluation for lobectomy by approach for patients with larger tumors who are clinically node negative.
This retrospective study analyzed 24 257 patients with clinical stage T2-3N0M0 non-small cell lung cancer from the National Cancer Database. Inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics. The rates of pathologic lymph node upstaging were compared. A Cox multivariable regression model was performed to test the association with overall survival.
After IPTW adjustment 20 834 patients were included in the analysis. Of these, 1996 patients underwent robotic lobectomy, 5122 patients underwent thoracoscopic lobectomy, and 13 725 patients underwent open lobectomy from 2010 to 2017. The IPTW-adjusted N1 upstaging rate was similar for robotic (11.79%), thoracoscopic (11.49%), and open (11.85%) lobectomy (P = .274). The adjusted N2 upstaging rates were 5.03%, 5.66%, and 6.15% for robotic, thoracoscopic, and open lobectomy, respectively (P = .274). On IPTW-adjusted multivariable analysis, robotic and thoracoscopic lobectomy were associated with improved survival compared with open lobectomy (P < .001).
There was no significant difference in N1 and N2 lymph node upstaging rates between surgical approaches for patients with clinical stage T2-3N0 non-small cell lung cancer, indicating similarly effective lymph node evaluation. Overall survival after robotic and thoracoscopic lobectomy was significantly better compared with open lobectomy in this patient population with a high propensity for occult nodal disease.
对于I期非小细胞肺癌，与开胸肺叶切除术相比，微创肺叶切除术的淋巴结评估可能具有同等疗效。我们试图比较临床淋巴结阴性的较大肿瘤患者行肺叶切除术时不同手术方式的淋巴结评估情况。
这项回顾性研究分析了来自国家癌症数据库的24257例临床分期为T2-3N0M0的非小细胞肺癌患者。采用治疗权重逆概率法（IPTW）来平衡基线特征。比较病理淋巴结分期上调的发生率。采用Cox多变量回归模型来检验与总生存期的相关性。
经过IPTW调整后，20834例患者纳入分析。其中，1996例患者接受了机器人辅助肺叶切除术，5122例患者接受了胸腔镜肺叶切除术，13725例患者在2010年至2017年间接受了开胸肺叶切除术。机器人辅助（11.79%）、胸腔镜（11.49%）和开胸（11.85%）肺叶切除术的IPTW调整后N1分期上调率相似（P = 0.274）。机器人辅助、胸腔镜和开胸肺叶切除术的调整后N2分期上调率分别为5.03%、5.66%和6.15%（P = 0.274）。在IPTW调整后的多变量分析中，与开胸肺叶切除术相比，机器人辅助和胸腔镜肺叶切除术与生存期改善相关（P < 0.001）。
临床分期为T2-3N0的非小细胞肺癌患者，不同手术方式的N1和N2淋巴结分期上调率无显著差异，表明淋巴结评估效果相似。在这类隐匿性淋巴结疾病高发的患者群体中，机器人辅助和胸腔镜肺叶切除术后的总生存期明显优于开胸肺叶切除术。
