机器人与胸腔镜肺叶切除术治疗 N1-2 期非小细胞肺癌的淋巴结清扫质量和早期复发：十一年高容量中心真实世界数据。
Quality of lymph node dissection and early recurrence in robotic versus thoracoscopic lobectomy for stage N1-2 non-small cell lung cancer: Eleven-year real-world data from a high-volume center.
机构信息
Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200300, China.
Department of Cardiothoracic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315040, China.
出版信息
Eur J Surg Oncol. 2024 Sep;50(9):108496. doi: 10.1016/j.ejso.2024.108496. Epub 2024 Jun 20.
BACKGROUND
The efficacy of lymph node dissection (LND) and oncological outcomes of robot-assisted (RL) versus video-assisted thoracoscopic lobectomy (VL) for non-small cell lung cancer (NSCLC) with nodal involvement remains controversial. This study aims to compare LND quality and early recurrence (ER) rate between RL and VL for stage N1-2 NSCLC patients based on eleven-year real-world data from a high-volume center.
METHODS
Pathologic stage IIB-IIIB (T1-3N1-2) NSCLC patients undergoing RL or VL in Shanghai Chest Hospital from 2010 to 2021 were retrospectively reviewed from a prospectively maintained database. Propensity-score matching (PSM, 1:4 RL versus VL) was performed to mitigate baseline differences. LND quality was evaluated by adequate (≥16) LND and nodal upstaging rates. ER was defined as recurrence occurring within 24 months post-surgery.
RESULTS
Out of 1578 cases reviewed, PSM yielded 200 RL and 800 VL cases. Without compromising perioperative outcomes, RL assessed more N1 and N2 LNs and N1 stations, and led to higher incidences of adequate LND (58.5 % vs. 42.0 %, p < 0.001) and nodal upstaging (p = 0.026), compared to VL. Notably, RL improved perioperative outcomes for patients undergoing adequate LND than VL. Finally, RL notably reduced ER rate (22.0 % vs. 29.6 %, p = 0.032), especially LN ER rate (15.0 % vs. 21.5 %, p = 0.041), and prolonged disease-free survival (DFS; hazard ratio = 0.837, p = 0.040) compared with VL. Further subgroup analysis of ER and DFS within the cN1-2-stage cohort verified this survival benefit.
CONCLUSIONS
RL surpasses VL in enhancing LND quality, reducing ER rates, and improving perioperative outcomes when adequate LND is performed for stage N1-2 NSCLC patients.
背景
对于有淋巴结转移的非小细胞肺癌（NSCLC），淋巴结清扫术（LND）的疗效和机器人辅助（RL）与电视辅助胸腔镜肺叶切除术（VL）的肿瘤学结果仍存在争议。本研究旨在根据来自高容量中心的十一年真实世界数据，比较 RL 和 VL 治疗 N1-2 期 NSCLC 患者的 LND 质量和早期复发（ER）率。
方法
回顾性分析 2010 年至 2021 年上海胸科医院接受 RL 或 VL 治疗的病理分期为 IIB-IIIB（T1-3N1-2）的 NSCLC 患者的前瞻性数据库。采用倾向评分匹配（PSM，1:4 RL 与 VL）来减轻基线差异。通过评估足够的（≥16）LND 和淋巴结升级率来评估 LND 质量。ER 定义为手术后 24 个月内复发。
结果
在 1578 例患者中，PSM 得出 200 例 RL 和 800 例 VL 病例。RL 不影响围手术期结果，但评估了更多的 N1 和 N2 淋巴结和 N1 站，并且导致更高的足够 LND（58.5%比 42.0%，p<0.001）和淋巴结升级（p=0.026）发生率，与 VL 相比。值得注意的是，RL 改善了接受足够 LND 的患者的围手术期结果，而不是 VL。最后，RL 显著降低了 ER 率（22.0%比 29.6%，p=0.032），尤其是淋巴结 ER 率（15.0%比 21.5%，p=0.041），并延长了无病生存期（DFS；风险比=0.837，p=0.040），与 VL 相比。在 cN1-2 期队列中对 ER 和 DFS 的进一步亚组分析验证了这种生存获益。
结论
当对 N1-2 期 NSCLC 患者进行足够的 LND 时，RL 在提高 LND 质量、降低 ER 率和改善围手术期结果方面优于 VL。
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