Ma Zelin, Zhang Yang, Han Han, Wang Shengping, Li Yuan, Chen Haiquan
Department of Thoracic Surgery and State Key Laboratory of Genetic Engineering, Fudan University Shanghai Cancer Center, Shanghai, China.
Institution of Thoracic Oncology, Fudan University, Shanghai, China.
Transl Lung Cancer Res. 2024 Jun 30;13(6):1201-1209. doi: 10.21037/tlcr-24-191. Epub 2024 Jun 22.
The Japan Clinical Oncology Group (JCOG) 1211 suggested that segmentectomy should be considered as standard treatment for clinical T1N0 (cT1N0) ground glass opacity (GGO). However, over half of patients in JCOG1211 had pre-/minimal invasive adenocarcinoma. This study aims to retrospectively investigate the long-term survival of GGO featured cT1N0 invasive lung adenocarcinoma undergoing segmentectomy or lobectomy.
This study screened patients with primary cT1N0 lung adenocarcinoma who received segmentectomy or lobectomy from 2010-2020. Prior computed tomography (CT) scans before surgery of all patients were reviewed and the inclusion was confirmed according to tumor diameter and consolidation tumor ratio (CTR). GGO nodules between 2-3 cm with CTR ≤0.5 or ≤2 cm with CTR between 0.25-0.5 were finally included. Patients with pathologically diagnosed pre-/minimally invasive lung adenocarcinoma were excluded. Long-term survivals between segmentectomy group and lobectomy group were compared after propensity score matching (PSM). Recurrence and postoperative complication events were also analyzed.
In total, 617 patients were enrolled, 159 received segmentectomy and 458 received lobectomy. Clinicopathological characteristics were well distributed between two groups. With a median follow-up time of 61.1 months (IQR: 42.3-71.7 months), after PSM, the 5-year overall survival rate was 98.8% (97.9-99.6%) for lobectomy and 99.3% (98.2-99.8%) for segmentectomy (P=0.42), the 5-year relapse-free survival rate was 95.3% (92.2-97.6%) for lobectomy and 95.2% for segmentectomy (92.3-98.7%) (P=0.81). The proportion of recurrence was 4.1% for lobectomy and 4.4% for segmentectomy (P=0.89). The proportion of grade 2 and above early postoperative complications was 9.6% for lobectomy and 8.8% for segmentectomy (P=0.86).
For cT1N0 GGO featured invasive lung adenocarcinoma (2 cm < tumor diameter ≤3 cm, CTR ≤0.5 or tumor diameter ≤2 cm, 0.25< CTR ≤0.5), postoperative outcomes between segmentectomy group and lobectomy group were comparable. Concerning minimally invasive surgical strategy, segmentectomy should be confirmed as the standard surgical approach.
日本临床肿瘤学会（JCOG）1211研究表明，肺段切除术应被视为临床T1N0（cT1N0）磨玻璃影（GGO）的标准治疗方法。然而，JCOG1211研究中超过半数的患者患有原位/微浸润腺癌。本研究旨在回顾性调查接受肺段切除术或肺叶切除术的以GGO为特征的cT1N0浸润性肺腺癌患者的长期生存情况。
本研究筛选了2010年至2020年期间接受肺段切除术或肺叶切除术的原发性cT1N0肺腺癌患者。回顾了所有患者术前的计算机断层扫描（CT）图像，并根据肿瘤直径和实性肿瘤比例（CTR）确定纳入标准。最终纳入肿瘤直径在2至3 cm且CTR≤0.5或肿瘤直径≤2 cm且CTR在0.25至0.5之间的GGO结节患者。排除病理诊断为原位/微浸润性肺腺癌的患者。在倾向得分匹配（PSM）后，比较肺段切除术组和肺叶切除术组的长期生存率。同时分析复发和术后并发症情况。
共纳入617例患者，其中159例行肺段切除术，458例行肺叶切除术。两组的临床病理特征分布均衡。中位随访时间为61.1个月（四分位间距：42.3 - 71.7个月），PSM后，肺叶切除术组的5年总生存率为98.8%（97.9 - 99.6%），肺段切除术组为99.3%（98.2 - 99.8%）（P = 0.42）；肺叶切除术组的5年无复发生存率为95.3%（92.2 - 97.6%），肺段切除术组为95.2%（92.3 - 98.7%）（P = 0.81）。肺叶切除术组的复发率为4.1%，肺段切除术组为4.4%（P = 0.89）。肺叶切除术组术后2级及以上早期并发症的发生率为9.6%，肺段切除术组为8.8%（P = 0.86）。
对于以cT1N0 GGO为特征的浸润性肺腺癌（2 cm＜肿瘤直径≤3 cm，CTR≤0.5或肿瘤直径≤2 cm，0.25＜CTR≤0.5），肺段切除术组和肺叶切除术组的术后结果相当。关于微创外科策略，肺段切除术应被确认为标准手术方式。
