Yoon Seung Keun, Moon Mi Hyoung, Kim Kyung Soo, Moon Seok Whan
Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
J Thorac Dis. 2024 Jul 30;16(7):4086-4096. doi: 10.21037/jtd-24-419. Epub 2024 Jun 27.
Computed tomography (CT)-guided transthoracic needle biopsy (TNB) could damage lung structures and may disseminate tumor cells into the airway, blood vessels, and pleural cavity, affecting post-operative outcomes. Several studies have investigated the effects of TNB on the prognosis of patients, but the effects remain unclear. This study aimed to investigate whether TNB increases the risk of recurrence of resected stage IA non-small cell lung cancer (NSCLC).
In this retrospective study, we enrolled 1,077 patients with stage IA NSCLC who underwent curative resection from 2010 to 2020. Recurrence risk factors were evaluated using Cox regression analyses. A multiple logistic regression model, including age, sex, smoking history, total tumor size, invasive tumor size, histology, histologic differentiation, lymphatic invasion, vascular invasion, perineural invasion, and the number of harvested lymph nodes (LNs), was used to calculate the propensity score.
According to the pre-operative TNB, patients were classified into the no-TNB (n=823) and TNB (n=190) groups. After propensity score matching analysis, 380 patients were included in the no-TNB group (1:2 matching). Multivariable Cox analysis revealed that pre-operative TNB was a negative prognostic factor in patients with surgically resected stage IA NSCLC [hazard ratio (HR), 3.15; 95% confidence interval (CI): 1.49-6.67; P=0.003]. The 5-year locoregional and overall recurrence-free survival (RFS) rates were significantly lower in the TNB group than in the no-TNB group (88.3% . 96.8%, P=0.001; and 84.2% . 93.7%, P=0.02, respectively).
For patients with stage IA NSCLC, pre-operative TNB was a negative prognostic factor for recurrence. Surgical diagnosis and treatment without pre-operative tissue diagnosis may be considered first in patients with clinically early lung cancer.
计算机断层扫描（CT）引导下的经胸针吸活检（TNB）可能会损伤肺结构，并可能将肿瘤细胞播散到气道、血管和胸腔中，从而影响术后结果。多项研究探讨了TNB对患者预后的影响，但结果仍不明确。本研究旨在调查TNB是否会增加IA期非小细胞肺癌（NSCLC）切除术后复发的风险。
在这项回顾性研究中，我们纳入了2010年至2020年间接受根治性切除的1077例IA期NSCLC患者。使用Cox回归分析评估复发风险因素。采用多因素logistic回归模型，包括年龄、性别、吸烟史、肿瘤总大小、浸润性肿瘤大小、组织学类型、组织学分化程度、淋巴血管浸润、神经周围浸润以及清扫淋巴结（LN）的数量，来计算倾向评分。
根据术前是否进行TNB，患者被分为未行TNB组（n = 823）和TNB组（n = 190）。经过倾向评分匹配分析后，未行TNB组纳入380例患者（1:2匹配）。多因素Cox分析显示，术前TNB是手术切除的IA期NSCLC患者的不良预后因素[风险比（HR），3.15；95%置信区间（CI）：1.49 - 6.67；P = 0.003]。TNB组的5年局部区域和总无复发生存率（RFS）显著低于未行TNB组（分别为88.3%对96.8%，P = 0.001；84.2%对93.7%，P = 0.02）。
对于IA期NSCLC患者，术前TNB是复发的不良预后因素。对于临床早期肺癌患者，可首先考虑不进行术前组织诊断的手术诊断和治疗。
