Kara Murat, Erdogdu Eren, Duman Salih, Fatalizade Gulnar, Ozkan Berker, Toker Alper
Department of Thoracic Surgery, Istanbul University Medical Faculty, Istanbul, Turkey.
Department of Cardiovascular and Thoracic Surgery, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA.
J Chest Surg. 2024 Sep 5;57(5):440-446. doi: 10.5090/jcs.23.166. Epub 2024 Jun 5.
Patients with early-stage lung tumors that are highly suspicious for malignancy typically undergo a preoperative diagnostic workup, primarily through bronchoscopy or transthoracic biopsy. Those without a preoperative diagnosis may alternatively be treated with upfront surgery, contingent upon the potential for intraoperative diagnosis. Previous studies have yielded conflicting results regarding the impact of upfront surgery on the survival of these patients. Our study aimed to elucidate the effect of upfront surgery on the survival outcomes of patients undergoing surgery for early-stage lung cancer without a preoperative diagnosis.
We analyzed the survival rate of 158 consecutive patients who underwent pulmonary resection for stage I lung cancer, either with or without a preoperative diagnosis.
A total of 86 patients (54%) underwent upfront surgery. This approach positively impacted both disease-free survival (p=0.031) and overall survival (p=0.017). However, no significant differences were observed across subgroups based on sex, smoking status, forced expiratory volume in 1 second, histologic tumor size, or histologic subtype. Univariate analysis identified upfront surgery (p=0.020), age (p=0.002), maximum standardized uptake value (SUVmax) exceeding 7 (p=0.001), and histological tumor size greater than 20 mm (p=0.009) as independent predictors. However, multivariate analysis indicated that only SUVmax greater than 7 (p=0.011) was a significant predictor of unfavorable survival.
Upfront surgery does not appear to confer a survival advantage in patients with stage I lung cancer undergoing surgical intervention.
早期肺部肿瘤高度怀疑为恶性的患者通常会接受术前诊断检查，主要通过支气管镜检查或经胸活检。那些没有术前诊断的患者可选择直接进行手术，但取决于术中诊断的可能性。先前的研究对于直接手术对这些患者生存的影响得出了相互矛盾的结果。我们的研究旨在阐明直接手术对未进行术前诊断的早期肺癌手术患者生存结局的影响。
我们分析了158例连续接受I期肺癌肺切除术的患者的生存率，这些患者有或没有术前诊断。
共有86例患者（54%）接受了直接手术。这种方法对无病生存率（p=0.031）和总生存率（p=0.017）均有积极影响。然而，在性别、吸烟状况、一秒用力呼气量、组织学肿瘤大小或组织学亚型等亚组中未观察到显著差异。单因素分析确定直接手术（p=0.020）、年龄（p=0.002）、最大标准化摄取值（SUVmax）超过7（p=0.001）和组织学肿瘤大小大于20 mm（p=0.009）为独立预测因素。然而，多因素分析表明，只有SUVmax大于7（p=0.011）是生存不良的显著预测因素。
对于接受手术干预的I期肺癌患者，直接手术似乎并未带来生存优势。
