Cui Shijun, Wang Gaoxiang, Huang Zhining, Wu Mingsheng, Wu Hanran, Zhou Hangcheng, Xu Meiqing, Xie Mingran
Department of Thoracic Surgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei 230001, China.
Department of Thoracic Surgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, China.
Zhongguo Fei Ai Za Zhi. 2024 May 20;27(5):359-366. doi: 10.3779/j.issn.1009-3419.2024.102.17.
With further understanding and research into non-small cell lung cancer with tumours ≤2 cm in maximum diameter, segmental lung resection is able to achieve the same long-term prognosis as lobectomy. However, there are few studies on the prognostic effect of wedge resection on small volume invasive lung adenocarcinoma with an invasion depth of 0.5 to 1.0 cm. Therefore, this study focuses on the clinical efficacy and prognosis of wedge resection in patients with small-volume invasive lung adenocarcinoma.
A retrospective analysis of the medical records of 208 patients who underwent surgery in the Department of Thoracic Surgery of the Affiliated Provincial Hospital of Anhui Medical University from February 2016 to December 2017 was made, and the postoperative pathological results confirmed small volume invasive lung adenocarcinoma. According to their surgical methods, they were divided into lobectomy group (n=115), segmentectomy group (n=48) and wedge resection group (n=45). Kaplan-Meier survival curve estimation and Cox proportional risk regression model were used to explore the influence of different surgical methods on the prognosis of patients with small volume invasive lung adenocarcinoma.
The wedge resection group had better perioperative outcomes compared with the segmentectomy group and lobectomy group, with statistically significant differences in intraoperative bleeding (P=0.036), postoperative drainage (P<0.001), operative time (P=0.018), postoperative time with tubes (P=0.001), and postoperative complication rate (P=0.006). There were no significant differences when comparing the three groups in terms of survival rate (lobectomy group vs segmentectomy group, P=0.303; lobectomy group vs wedge resection group, P=0.742; and segmentectomy group vs wedge resection group, P=0.278) and recurrence-free survival rate (lobectomy group vs segmentectomy group, P=0.495; lobectomy group vs wedge resection group, P=0.362; segmentectomy group vs wedge resection group, P=0.775). Univariate and multivariate survival analyses showed that consolidation tumor ratio (CTR) was the prognostic factor of overall survival and revurrence-free survival for patients with small-volume invasive lung adenocarcinoma (P<0.05).
Wedge resection in patients with small volume invasive lung adenocarcinoma can achieve long-term outcomes similar to segmentectomy and lobectomy. When the CTR≤0.5, wedge resection is preferred in such patients.
随着对最大直径≤2 cm的非小细胞肺癌的进一步认识和研究，肺段切除术能够取得与肺叶切除术相同的长期预后。然而，关于楔形切除术对浸润深度为0.5至1.0 cm的小体积浸润性肺腺癌预后影响的研究较少。因此，本研究聚焦于小体积浸润性肺腺癌患者楔形切除术的临床疗效和预后。
回顾性分析2016年2月至2017年12月在安徽医科大学附属省立医院胸外科接受手术的208例患者的病历，术后病理结果确诊为小体积浸润性肺腺癌。根据手术方式，将其分为肺叶切除组（n = 115）、肺段切除组（n = 48）和楔形切除组（n = 45）。采用Kaplan-Meier生存曲线估计和Cox比例风险回归模型，探讨不同手术方式对小体积浸润性肺腺癌患者预后的影响。
与肺段切除组和肺叶切除组相比，楔形切除组围手术期结局更好，在术中出血（P = 0.036）、术后引流量（P < 0.001）、手术时间（P = 0.018）、带管时间（P = 0.001）和术后并发症发生率（P = 0.006）方面差异有统计学意义。三组在生存率（肺叶切除组与肺段切除组，P = 0.303；肺叶切除组与楔形切除组，P = 0.742；肺段切除组与楔形切除组，P = 0.278）和无复发生存率（肺叶切除组与肺段切除组，P = 0.495；肺叶切除组与楔形切除组，P = 0.362；肺段切除组与楔形切除组，P = 0.775）方面比较，差异无统计学意义。单因素和多因素生存分析显示，实性肿瘤比例（CTR）是小体积浸润性肺腺癌患者总生存和无复发生存的预后因素（P < 0.05）。
小体积浸润性肺腺癌患者行楔形切除术可取得与肺段切除术和肺叶切除术相似的长期疗效。当CTR≤0.5时，此类患者首选楔形切除术。
