Ucvet Ahmet, Yazgan Serkan, Agaoglu Sanli Bahar, Yamansavci Sirzai Esra
Health Sciences University, Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, Turkey.
Updates Surg. 2023 Oct;75(7):2017-2025. doi: 10.1007/s13304-023-01616-2. Epub 2023 Aug 10.
Controversy still exists regarding the staging of non-small cell lung cancer (NSCLC) with adjacent lobe invasion (T-ALI) according to the TNM system in terms of T factor and the appropriate surgical resection method. We performed an analysis to compare the prognosis of T-ALI with T2 and T3 disease and to see the effect of our surgical method for these tumors. Two hundred consecutive patients between January 2012 and November 2020, with anatomical lobectomy for T2 or T3 tumor (Group-1) and non-anatomical lobectomy resection (lobectomy plus wedge resection [LWR]) (Group-2) for T-ALI (T2-ALI and T3-ALI) due to primary NSCLC, who did not have lymph node metastases were analyzed retrospectively. All surgeries were performed by two experienced surgeons who adopted the same surgical technique. Those who underwent additional segmentectomy and bilobectomy due to fissure invasion were excluded from the study. Overall survival rates of all patients were determined and factors affecting survival were evaluated by performing univariate and multivariate analyses. Of the patients with a mean age of 62.2 ± 7.8 years, 175 (87.5%) were male and 25 (12.5%) were female. There were 137 (68.5%) patients in Group 1 and 63 (31.5%) patients in Group 2. The mean tumor size in Group 1 (4.4 ± 1.4 cm) was significantly smaller than that in Group 2 (4.9 ± 1.4 cm) (p = 0.014). When T distribution within the groups was considered, the rate of pathological T3 in Group 1 (33.6%) was significantly lower than that in Group 2 (55.6%) (p = 0.005). While the 5-year overall survival rate was 70.1% in Group 1, it was 50.6% in Group 2 (p = 0.022). When tumors were grouped as T2, T2-ALI, T3, and T3-ALI according to T factor, the 5-year overall survival rates were 71.4% and 67.8% in T2 and T3 tumors, respectively, and 49.2% and 51.5% in T2-ALI and T3-ALI tumors, respectively. In the multivariate analysis of these four groups, the overall survival rates for T2-ALI and T3-ALI were significantly lower than those of T2 tumors (p = 0.046 and p = 0.025, respectively). In the analysis made between the T2 tumor group and the new T3 group (T2-ALI, T3, T3-ALI), which was formed by upgrading T2-ALI tumors to the T3 group, T2 tumors were found to have a significantly better survival rate (p = 0.019). The disease-free survival of pT2 patients and new T3 group patients was statistically significant, 63.7% and 45.7%, respectively (p = 0.050). Our results suggest that LWR for T-ALI can be performed with acceptable oncologic outcomes when compared to anatomical lobectomy. T2-ALI has a worse overall survival than T2 tumor and offers a similar prognosis to T3. Given this situation, it is more appropriate to classify T2-ALI as T3. Further studies based on larger series are needed to confirm these preliminary data.
根据TNM系统，非小细胞肺癌（NSCLC）伴相邻肺叶侵犯（T-ALI）在T分期及合适的手术切除方法方面仍存在争议。我们进行了一项分析，以比较T-ALI与T2和T3期疾病的预后，并观察我们对这些肿瘤的手术方法的效果。对2012年1月至2020年11月期间连续200例因原发性NSCLC行T2或T3肿瘤解剖性肺叶切除术（第1组）以及T-ALI（T2-ALI和T3-ALI）行非解剖性肺叶切除术（肺叶切除术加楔形切除术[LWR]）（第2组）且无淋巴结转移的患者进行回顾性分析。所有手术均由两位采用相同手术技术的经验丰富的外科医生进行。因肺裂侵犯而接受额外肺段切除术和双肺叶切除术的患者被排除在研究之外。确定所有患者的总生存率，并通过单因素和多因素分析评估影响生存的因素。患者平均年龄为62.2±7.8岁，其中175例（87.5%）为男性，25例（12.5%）为女性。第1组有137例（68.5%）患者，第2组有63例（31.5%）患者。第1组的平均肿瘤大小（4.4±1.4 cm）明显小于第2组（4.9±1.4 cm）（p = 0.014）。考虑组内T分布时，第1组的病理T3率（33.6%）明显低于第2组（55.6%）（p = 0.005）。第1组的5年总生存率为70.1%，第2组为50.6%（p = 0.022）。根据T因子将肿瘤分为T2、T2-ALI、T3和T3-ALI组时，T2和T3肿瘤的5年总生存率分别为71.4%和67.8%，T2-ALI和T3-ALI肿瘤分别为49.2%和51.5%。在这四组的多因素分析中，T2-ALI和T3-ALI的总生存率明显低于T2肿瘤（分别为p = 0.046和p = 0.025）。在T2肿瘤组与通过将T2-ALI肿瘤升级为T3组而形成的新T3组（T2-ALI、T3、T3-ALI）之间的分析中，发现T2肿瘤的生存率明显更好（p = 0.019）。pT2患者和新T3组患者的无病生存率分别为63.7%和45.7%，差异有统计学意义（p = 0.050）。我们的结果表明，与解剖性肺叶切除术相比，T-ALI行LWR可获得可接受的肿瘤学结果。T2-ALI的总生存率比T2肿瘤差，与T3的预后相似。鉴于这种情况，将T2-ALI归类为T3更为合适。需要基于更大样本量的进一步研究来证实这些初步数据。
