非小细胞肺癌患者行肺段切除术与肺叶切除术后的总体5年生存率及无病生存率。
Overall 5-year survival rate and disease-free survival after segmentectomy versus lobectomy in patients with non-small cell lung cancer.
作者信息
Kadeetham Khunthorn, Ngodngamthaweesuk Montien, Kantathut Narongrit, Samankatiwat Piya, Cherntanomwong Piya, Leelayana Parinya, Khajarern Siam
机构信息
Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
出版信息
SAGE Open Med. 2022 Dec 16;10:20503121221142171. doi: 10.1177/20503121221142171. eCollection 2022.
OBJECTIVES
Anatomical lobectomy has always been the standard operative treatment of early-stage non-small cell lung cancer. However, there have been emerging evidences suggesting that a subanatomical resection, such as segmentectomy, may yield the same treatment results, even in patients with higher-stage non-small cell lung cancer. This study aimed to compare overall 5-year survival rate and disease-free survival between lobectomy and segmentectomy in patients with non-small cell lung cancer.
METHODS
The retrospective study included 380 patients who underwent surgery for non-small cell lung cancer at Ramathibodi Hospital between 1st January 2016 and 31st December 2020. Of 380 patients, 307 patients underwent lobectomy, while the other 73 patients underwent segmentectomy. Operative, admission, and follow-up data were collected from electronic medical records. Missing data were collected by telephone calls to patients or their relatives in deceased cases. Overall and disease-free survival were analyzed.
RESULTS
Median overall 5-year survival time after lobectomy and segmentectomy seemed to be different but not statistically significant (18.5 months versus 5.8 months, = 0.127). Median disease-free survival time after lobectomy and segmentectomy was also similar (8.6 months versus 4.5 months, = 0.511). Two deaths occurred during perioperative period, one from lobectomy group due to acute massive pulmonary embolism (0.3%) and the other from segmentectomy group due to acute exacerbation of chronic obstructive pulmonary disease with respiratory failure (1.4%).
CONCLUSION
Lobectomy and segmentectomy result in similar overall 5-year survival rate and disease-free survival between these two comparison groups. Therefore, segmentectomy may be a potential alternative for operative treatment of non-small cell lung cancer. However, a larger and randomized-controlled trial may be needed to further validate these results.
目的
解剖性肺叶切除术一直是早期非小细胞肺癌的标准手术治疗方法。然而，越来越多的证据表明，亚解剖性切除，如肺段切除术，即使在更高分期的非小细胞肺癌患者中，也可能产生相同的治疗效果。本研究旨在比较非小细胞肺癌患者肺叶切除术和肺段切除术的总体5年生存率和无病生存率。
方法
这项回顾性研究纳入了2016年1月1日至2020年12月31日在拉玛蒂博迪医院接受非小细胞肺癌手术的380例患者。在380例患者中，307例行肺叶切除术，另外73例行肺段切除术。手术、入院和随访数据从电子病历中收集。在死亡病例中，通过电话联系患者或其亲属收集缺失数据。分析总体生存率和无病生存率。
结果
肺叶切除术和肺段切除术后的总体5年生存时间中位数似乎不同，但无统计学意义（18.5个月对5.8个月，P = 0.127）。肺叶切除术和肺段切除术后的无病生存时间中位数也相似（8.6个月对4.5个月，P = 0.511）。围手术期发生2例死亡，1例来自肺叶切除组，死于急性大面积肺栓塞（0.3%），另1例来自肺段切除组，死于慢性阻塞性肺疾病急性加重伴呼吸衰竭（1.4%）。
结论
肺叶切除术和肺段切除术在这两个比较组中的总体5年生存率和无病生存率相似。因此，肺段切除术可能是治疗非小细胞肺癌的一种潜在替代方法。然而，可能需要更大规模的随机对照试验来进一步验证这些结果。
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