Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
Department of Chest Surgery, St Marianna University School of Medicine, Kanagawa, Japan.
Ann Thorac Surg. 2023 Sep;116(3):543-551. doi: 10.1016/j.athoracsur.2023.02.061. Epub 2023 Mar 31.
Segmentectomy is a good surgical option for peripheral, early, non-small cell lung cancer (NSCLC) ≤2 cm. However, the role of sublobar resection including wedge resection and segmentectomy remains unclear for octogenarians with >2-cm but ≤4-cm early-stage NSCLC, for which lobectomy is a standard treatment.
By use of a prospective registry, 892 patients aged ≥80 years with operable lung cancer were enrolled at 82 institutions. Of these, we analyzed the clinicopathologic findings and surgical outcomes of 419 patients with NSCLC tumors of 2 to 4 cm during a median follow-up of 50.9 months between April 2015 and December 2016.
Five-year overall survival (OS) was slightly but not significantly worse after sublobar resection than after lobectomy in the entire cohort (54.7% [95% CI, 43.2%-93.0%] vs 66.8% [95% CI, 60.8%-72.1%]; P = .09). Multivariable Cox regression analysis of OS revealed that these surgical procedures were not independent prognostic predictors (hazard ratio, 0.8 [0.5-1.1]; P = .16). The 5-year OS was comparable between 192 patients who could tolerate lobectomy but were treated by sublobar resection or lobectomy (67.5% [95% CI, 48.8%-80.6%] vs 71.5% [95% CI, 62.9%-78.4%]; P = .79). Recurrence after sublobar resection and lobectomy was locoregional in 11 (11%) of 97 and in 23 (7%) of 322 patients, respectively.
OS might be equivalent between sublobar resection with a secure surgical margin and lobectomy for selected patients aged ≥80 years with peripheral early-stage NSCLC tumors of 2 to 4 cm who can tolerate lobectomy.
对于外周、早期、非小细胞肺癌（NSCLC）≤2cm 的患者，肺段切除术是一种很好的手术选择。然而，对于 2cm 但≤4cm 早期 NSCLC 的 80 岁以上患者，亚肺叶切除术（包括楔形切除术和肺段切除术）的作用仍不明确，因为肺叶切除术是标准治疗方法。
通过使用前瞻性登记，82 家机构共纳入了 892 名年龄≥80 岁的可手术肺癌患者。在此基础上，我们分析了 2015 年 4 月至 2016 年 12 月期间中位随访 50.9 个月的 419 名 NSCLC 肿瘤 2 至 4cm 的患者的临床病理特征和手术结果。
在整个队列中，亚肺叶切除术后 5 年总生存率（OS）略低于肺叶切除术，但无统计学意义（54.7%[95%CI，43.2%-93.0%]vs66.8%[95%CI，60.8%-72.1%]；P=0.09）。OS 的多变量 Cox 回归分析显示，这些手术程序不是独立的预后预测因素（风险比，0.8[0.5-1.1]；P=0.16）。192 名能够耐受肺叶切除术但接受亚肺叶切除术或肺叶切除术的患者的 5 年 OS 相当（67.5%[95%CI，48.8%-80.6%]vs71.5%[95%CI，62.9%-78.4%]；P=0.79）。亚肺叶切除术和肺叶切除术后的复发分别为局部区域复发 11 例（11%）和 322 例（7%）。
对于能够耐受肺叶切除术的外周早期 NSCLC 肿瘤为 2 至 4cm、年龄≥80 岁的患者，在保证安全切缘的情况下，亚肺叶切除术与肺叶切除术的 OS 可能相当。
