Han Rui, Zhang Fan, Zhan Chang, Hong Qian, Zhao Chenguang, Djaferi Visar, Wang Fuquan, Qi Pengfei, Muhammad Shan, Li Fang, Li Jiagen, Mu Juwei
Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Thoracic Surgery, Shandong Public Health Clinical Center, Shandong University, Jinan, China.
Transl Lung Cancer Res. 2024 Nov 30;13(11):3050-3066. doi: 10.21037/tlcr-24-685. Epub 2024 Nov 27.
In the treatment of central-type non-small cell lung cancer (NSCLC), sleeve lobectomy (SL) has emerged as the surgical treatment of choice over pneumonectomy (PN). This retrospective study evaluates the clinical profiles and prognostic elements impacting survival and recurrence rates in patients who underwent SL.
We retrospectively analyzed 288 patients who underwent SL from January 2010 to December 2023. Survival analysis was performed using the Kaplan-Meier method, and survival curves were subsequently drawn. Factors predicting SL outcomes were investigated through univariate and multivariable Cox regression analyses.
Univariate and multivariable analyses consistently demonstrated significant variations in overall survival (OS) and disease-free survival (DFS) among subgroups receiving neoadjuvant therapy (NT), which also stood out as independent prognostic factors. Patients undergoing NT showed enhanced OS [hazard ratio (HR) =0.4652, 95% confidence interval (CI): 0.3042-0.7116, P=0.004] and DFS (HR =0.5182, 95% CI: 0.3243-0.8279, P=0.01). Earlier pT stages were associated with better prognosis (P<0.05). Significant differences in both OS and DFS were noted across pN stages, with earlier stages indicating improved prognosis; this was a significant independent factor for DFS (P<0.001). Similar significant trends were observed across pathological Tumor-Node-Metastasis (pTNM) stages, with earlier stages linked to better outcomes. Additionally, body mass index (BMI) was identified as an independent prognostic factor for both OS and DFS. Clinical T stage independently influenced DFS. No significant prognostic disparities were observed in other clinical characteristics (P>0.05).
NT significantly improves the prognosis for NSCLC patients undergoing SL. Pathological staging is proven to be more indicative of prognosis than clinical staging. Understanding the staging of lymph nodes (LNs) is crucial for predicting the long-term recurrence risk in patients with NSCLC who undergo SL treatment. Mediastinal and hilar LN dissection is especially important in minimizing this risk and improving prognosis.
在中央型非小细胞肺癌（NSCLC）的治疗中，袖状肺叶切除术（SL）已成为优于全肺切除术（PN）的手术治疗选择。这项回顾性研究评估了接受SL治疗的患者的临床特征以及影响生存和复发率的预后因素。
我们回顾性分析了2010年1月至2023年12月期间接受SL治疗的288例患者。采用Kaplan-Meier方法进行生存分析，随后绘制生存曲线。通过单因素和多因素Cox回归分析研究预测SL治疗结果的因素。
单因素和多因素分析一致表明，接受新辅助治疗（NT）的亚组之间总生存期（OS）和无病生存期（DFS）存在显著差异，NT也是独立的预后因素。接受NT的患者OS [风险比（HR）=0.4652，95%置信区间（CI）：0.3042 - 0.7116，P = 0.004]和DFS（HR = 0.5182，95% CI：0.3243 - 0.8279，P = 0.01）均有所改善。较早的pT分期与较好的预后相关（P < 0.05）。OS和DFS在不同pN分期之间均存在显著差异，分期越早预后越好；这是DFS的一个显著独立因素（P < 0.001）。在病理肿瘤-淋巴结-转移（pTNM）分期中也观察到类似的显著趋势，分期越早结局越好。此外，体重指数（BMI）被确定为OS和DFS的独立预后因素。临床T分期独立影响DFS。在其他临床特征方面未观察到显著的预后差异（P > 0.05）。
NT显著改善了接受SL治疗的NSCLC患者的预后。病理分期被证明比临床分期更能指示预后。了解淋巴结（LN）分期对于预测接受SL治疗的NSCLC患者的长期复发风险至关重要。纵隔和肺门LN清扫对于将这种风险降至最低并改善预后尤为重要。
