Peng Terrance, Wightman Sean C, Ding Li, Lieu Dustin K, Atay Scott M, David Elizabeth A, Kim Anthony W
Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, Calif.
Department of Preventive Medicine, Keck School of Medicine of USC, Los Angeles, Calif.
JTCVS Open. 2022 Apr 14;10:356-367. doi: 10.1016/j.xjon.2022.03.002. eCollection 2022 Jun.
The objective was to compare overall survival (OS) between lobectomy and segmentectomy for patients with non-small cell lung cancers (NSCLCs) > 2 but ≤4 cm.
The National Cancer Database was queried to identify treatment-naïve patients with NSCLC tumors >2 but ≤4 cm. Eligible patients were diagnosed with pT1 or T2 N0 M0 disease, underwent lobectomy or segmentectomy, and received no adjuvant therapy. OS was compared using the Kaplan-Meier method, and the Cox proportional-hazards model was used to identify prognostic factors for death. Propensity score matching was performed to minimize the effects of potential confounders.
Included were 32,792 patients: lobectomy (n = 31,353) and segmentectomy (n = 1439). Five-year OS was improved following lobectomy over segmentectomy for patients with >2 but ≤4 cm NSCLCs (62.3% vs 52.6%; < .0001). Further stratification demonstrated improved 5-year OS following lobectomy over segmentectomy: >2 but ≤3 cm (64.9% vs 54.3%; < .0001) and >3 but ≤4 cm (56.9% vs 47.6%; = .0003). In patients with a Charlson-Deyo comorbidity index of 0, 5-year OS was greater following lobectomy for >2 but ≤4 cm tumors (67.1% vs 62.1%; = .03). Further stratification demonstrated improved 5-year OS following lobectomy for patients with Charlson-Deyo comorbidity index of 0 and > 3 but ≤4 cm tumors (61.8% vs 54.6%; = .02). Segmentectomy was prognostic for increased risk of death in the year 1 through 5 postoperative period (hazard ratio, 1.35; < .0001). Five-year OS remained greater following lobectomy after propensity score matching (59.6% vs 52.7%; = .02).
Lobectomy is associated with superior 5-year OS compared with segmentectomy and may be preferred for NSCLC tumors >2 but ≤4 cm when feasible.
比较肺叶切除术和肺段切除术治疗肿瘤大小＞2cm但≤4cm的非小细胞肺癌（NSCLC）患者的总生存期（OS）。
查询国家癌症数据库，以确定初治的肿瘤大小＞2cm但≤4cm的NSCLC患者。符合条件的患者被诊断为pT1或T2 N0 M0期疾病，接受了肺叶切除术或肺段切除术，且未接受辅助治疗。采用Kaplan-Meier法比较总生存期，并使用Cox比例风险模型确定死亡的预后因素。进行倾向评分匹配以尽量减少潜在混杂因素的影响。
共纳入32792例患者，其中肺叶切除术31353例，肺段切除术1439例。肿瘤大小＞2cm但≤4cm的NSCLC患者，肺叶切除术后的5年总生存期优于肺段切除术（62.3%对52.6%；P＜0.0001）。进一步分层分析显示，肺叶切除术后的5年总生存期仍优于肺段切除术：肿瘤大小＞2cm但≤3cm（64.9%对54.3%；P＜0.0001），以及肿瘤大小＞3cm但≤4cm（56.9%对47.6%；P = 0.0003）。Charlson-Deyo合并症指数为0的患者，肿瘤大小＞2cm但≤4cm时，肺叶切除术后的5年总生存期更长（67.1%对62.1%；P = 0.03）。进一步分层分析显示，Charlson-Deyo合并症指数为0且肿瘤大小＞3cm但≤4cm的患者，肺叶切除术后的5年总生存期有所改善（61.8%对54.6%；P = 0.02）。肺段切除术是术后1至5年死亡风险增加的预后因素（风险比，1.35；P＜0.0001）。倾向评分匹配后，肺叶切除术后的5年总生存期仍然更长（59.6%对52.7%；P = 0.02）。
与肺段切除术相比，肺叶切除术的5年总生存期更佳，对于可行的肿瘤大小＞2cm但≤4cm的NSCLC患者，肺叶切除术可能是更优选择。
