Li Jianfeng, Zhu Hongjie, Luo Nanzhi, Zhou Wenjing, Dai Fuqiang, Wang Xintian, Wu Xiaoli
Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China.
Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China.
Discov Oncol. 2024 Oct 23;15(1):585. doi: 10.1007/s12672-024-01468-1.
The optimal surgical approach for elderly patients with early-stage non-small cell lung cancer (NSCLC) remains a topic of debate. A retrospective analysis was conducted on patients who underwent pulmonary resection for early-stage NSCLC at our single institution between January 2018 and December 2022. Propensity score matching was used to balance baseline characteristics between the sublobar resection and lobectomy groups. Perioperative outcomes, pulmonary function recovery, postoperative quality of life, and survival were compared between the two groups. A total of 151 patients were included, with 42 undergoing sublobar resection and 109 undergoing lobectomy. After propensity score matching, baseline characteristics were well-balanced between the two groups. Sublobar resection was associated with shorter operative time (125.83 ± 33.56 min vs. 161.14 ± 61.54 min, p = 0.048), less intraoperative blood loss [65 (30, 75) ml vs. 120 (70, 170) ml, p < 0.001], shorter drainage duration [3 (2, 5) days vs. 5 (3, 6) days, p < 0.001], shorter hospital stay [6 (4, 8) days vs. 10 (7, 13) days, p < 0.001], and fewer postoperative complications (11.9% vs. 47.6%, p < 0.001), compared to lobectomy. Moreover, sublobar resection led to better pulmonary function recovery and higher postoperative quality of life scores, with no significant difference in overall and disease-free survival between the groups. Sublobar resection in patients aged 80 and above with early-stage NSCLC offered comparable oncological outcomes to lobectomy while preserving more lung function and providing better postoperative recovery and long-term quality of life. These findings have important implications for treatment decision-making in elderly NSCLC patients.
老年早期非小细胞肺癌（NSCLC）的最佳手术方式仍是一个有争议的话题。对2018年1月至2022年12月期间在我们单中心接受早期NSCLC肺切除术的患者进行了回顾性分析。采用倾向评分匹配法平衡亚肺叶切除组和肺叶切除组之间的基线特征。比较两组的围手术期结局、肺功能恢复情况、术后生活质量和生存率。共纳入151例患者，其中42例行亚肺叶切除，109例行肺叶切除。倾向评分匹配后，两组的基线特征得到了良好平衡。与肺叶切除相比，亚肺叶切除的手术时间更短（125.83±33.56分钟 vs. 161.14±61.54分钟，p = 0.048），术中出血量更少[65（30，75）ml vs. 120（70，170）ml，p < 0.001]，引流时间更短[3（2，5）天 vs. 5（3，6）天，p < 0.001]，住院时间更短[6（4，8）天 vs. 10（7，13）天，p < 0.001]，术后并发症更少（11.9% vs. 47.6%，p < 0.001）。此外，亚肺叶切除导致更好的肺功能恢复和更高的术后生活质量评分，两组之间的总生存率和无病生存率无显著差异。80岁及以上早期NSCLC患者的亚肺叶切除在肿瘤学结局方面与肺叶切除相当，同时保留了更多的肺功能，术后恢复更好，长期生活质量更高。这些发现对老年NSCLC患者的治疗决策具有重要意义。
