Chae Kum Ju, Hong Hyunsook, Park Hyungin, Yoon Soon Ho
Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea.
Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea.
Cancer Res Treat. 2025 Apr;57(2):387-400. doi: 10.4143/crt.2024.560. Epub 2024 Sep 2.
We aim to determine whether preoperative percutaneous needle aspiration or biopsy (PCNA/Bx) increases recurrence risk and reduces survival in stage I lung cancer patients, using a nationwide lung cancer registry.
We retrospectively included 3,452 patients diagnosed with stage I lung cancer who underwent curative surgery between 2014 and 2019, as recorded in the Korean Association of Lung Cancer Registry. To balance the characteristics of patients with and without PCNA/Bx, we applied inverse probability of treatment weighting. We used cumulative incidence plots and a weighted subdistribution hazard model to analyze time to recurrence. Recurrence-free survival and overall survival were analyzed using Kaplan-Meier curves and weighted Cox proportional hazard ratio models.
In patients with adenocarcinoma, the use of PCNA/Bx was associated with a 1.9-fold increase (95% confidence interval [CI], 1.5 to 2.4) in the risk of recurrence and a 1.7-fold decrease (95% CI, 1.3 to 2.2) in recurrence-free survival. Subgroup analysis based on pathologic pleural invasion revealed that the risk of recurrence increased when PCNA/Bx was performed, with 2.1-fold (95% CI, 1.5 to 2.8) in patients without pleural invasion and 1.6-fold (95% CI, 1.0 to 2.4) in those with pleural invasion. No association was found between the use of PCNA/Bx and overall survival.
Preoperative PCNA/Bx was associated with increased recurrence risks in stage I adenocarcinoma, regardless of pathologic pleural invasion status. In early lung cancer cases where adenocarcinoma is strongly suspected and curative surgery is feasible, the use of transthoracic biopsy should be approached with caution.
我们旨在利用全国肺癌登记处的数据，确定术前经皮针吸活检（PCNA/Bx）是否会增加I期肺癌患者的复发风险并降低其生存率。
我们回顾性纳入了2014年至2019年间在韩国肺癌登记处记录的3452例接受根治性手术的I期肺癌患者。为平衡接受和未接受PCNA/Bx患者的特征，我们应用了治疗权重的逆概率法。我们使用累积发病率图和加权亚分布风险模型分析复发时间。无复发生存率和总生存率使用Kaplan-Meier曲线和加权Cox比例风险比模型进行分析。
在腺癌患者中，使用PCNA/Bx与复发风险增加1.9倍（95%置信区间[CI]，1.5至2.4）以及无复发生存率降低1.7倍（95%CI，1.3至2.2）相关。基于病理胸膜侵犯的亚组分析显示，进行PCNA/Bx时复发风险增加，无胸膜侵犯患者增加2.1倍（95%CI，1.5至2.8），有胸膜侵犯患者增加1.6倍（95%CI，1.0至2.4）。未发现PCNA/Bx的使用与总生存率之间存在关联。
术前PCNA/Bx与I期腺癌复发风险增加相关，无论病理胸膜侵犯状态如何。在高度怀疑为腺癌且可行根治性手术的早期肺癌病例中，应谨慎使用经胸活检。
