T1N0M0期非小细胞肺癌患者肺叶切除术前楔形切除术：一项倾向评分匹配分析
Wedge resection before lobectomy for patients with T1N0M0 non-small cell lung cancer: a propensity score matching analysis.
作者信息
Zeng Yuan, Huang Ying, Fu Junhui, Xu Ke, Liang Wenhua, Cui Fei, Hao Zhexue, Li Xukai, Xing Tuo, He Jianxing, Liu Jun
机构信息
Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China.
Department of Surgical Oncology, Shantou Central Hospital, Shantou, China.
出版信息
Ann Transl Med. 2022 May;10(9):502. doi: 10.21037/atm-21-5246.
BACKGROUND
Whether wedge resection of a tumor before lobectomy (Wed + Lob) can improve the prognosis of non-small cell lung cancer (NSCLC) has yet to be determined comprehensively. This study aimed to compare the effects of Wed + Lob with those of direct lobectomy (Lob) on survival and tumor cell dissemination in patients with T1N0M0 NSCLC.
METHODS
A cohort of 813 patients with T1N0M0 NSCLC who underwent lobectomy at a single center in China was investigated. After propensity score matching, the overall survival (OS) and disease-free survival (DFS) of patients were estimated using Kaplan-Meier plots. Associations between surgical strategies and patient survival were computed as hazard ratios and 95% confidence intervals using Cox proportional hazards regression models. Changes in folate receptor-positive circulating tumor cells (FR+ CTCs) after lobectomy were analyzed in another cohort from our hospital.
RESULTS
A total of 401 Wed + Lob cases were matched with 255 Lob cases according to their propensity scores. Although no significant differences were found in OS, multivariate analysis showed that patients with T1N0M0 NSCLC in the Wed + Lob group had significantly improved DFS (HR =0.583; P=0.012) compared to those in the Lob group. After surgery, a decrease in FR+ CTCs was observed in 21 of 23 patients (91.3%) in the Wed + Lob group and in 16 of 23 patients (69.6%) in the Lob group [mean changes: 6.10 (±7.80) FU per 3 mL 1.31 (±4.39) FU per 3 mL; P=0.014].
CONCLUSIONS
Wed + Lob may improve DFS and reduce tumor cell dissemination in patients with T1N0M0 NSCLC.
背景
在肺叶切除术之前对肿瘤进行楔形切除（楔形切除 + 肺叶切除）是否能改善非小细胞肺癌（NSCLC）的预后，尚未得到全面确定。本研究旨在比较楔形切除 + 肺叶切除与直接肺叶切除对 T1N0M0 期 NSCLC 患者生存及肿瘤细胞播散的影响。
方法
对在中国某单一中心接受肺叶切除术的 813 例 T1N0M0 期 NSCLC 患者进行队列研究。经过倾向评分匹配后，采用 Kaplan-Meier 曲线估计患者的总生存期（OS）和无病生存期（DFS）。使用 Cox 比例风险回归模型计算手术策略与患者生存之间的关联，以风险比和 95%置信区间表示。在我院的另一队列中分析肺叶切除术后叶酸受体阳性循环肿瘤细胞（FR + CTCs）的变化。
结果
根据倾向评分，共 401 例楔形切除 + 肺叶切除病例与 255 例肺叶切除病例相匹配。虽然在总生存期方面未发现显著差异，但多因素分析显示，与肺叶切除组相比，楔形切除 + 肺叶切除组的 T1N0M0 期 NSCLC 患者的无病生存期显著改善（HR = 0.583；P = 0.012）。术后，楔形切除 + 肺叶切除组 23 例患者中有 21 例（91.3%）观察到 FR + CTCs 减少，肺叶切除组 23 例患者中有 16 例（69.6%）观察到 FR + CTCs 减少[平均变化：每 3 mL 6.10（±7.80）荧光单位对每 3 mL 1.31（±4.39）荧光单位；P = 0.014]。
结论
楔形切除 + 肺叶切除可能改善 T1N0M0 期 NSCLC 患者的无病生存期并减少肿瘤细胞播散。
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