Whitehorn Gregory L, Rshaidat Hamza, Madeka Isheeta, Martin Jonathan, Mack Shale J, Meredith Luke, Alaparthi Sneha, Grenda Tyler R, Evans Nathaniel R, Okusanya Olugbenga T
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
Clin Lung Cancer. 2025 Mar;26(2):e99-e107.e10. doi: 10.1016/j.cllc.2024.11.007. Epub 2024 Nov 18.
The purpose of this study is to utilize a representative national sample to compare survival outcomes of patients with visceral pleural invasion (VPI) who underwent either a lobectomy or a segmentectomy.
National Cancer Database from 2010 to 2019 was utilized. Patients with tumor size ≤ 2 cm, with VPI, non-small cell lung cancer (NSCLC), with a known vital status were included in the study. A propensity match analysis was performed to compare VPI patients undergoing either lobectomy or segmentectomy.
Of the 66,181 patients who met the inclusion criteria, 6,575 (9.9%) had VPI. In postmatch analysis, there was no significant difference in 5-year survival in patients whose cancer had VPI and underwent either lobectomy or segmentectomy (76 [77.1%] vs. 71 [65.7%]; P = .23). Patients who underwent lobectomy and had VPI had poorer 5-year survival compared to patients who underwent a lobectomy and did not have VPI (1,154 [73.7%] vs. 1,240 [78.5%]; P < .001). There was no difference in 5-year survival between patients who underwent a segmentectomy and had VPI and patients who underwent a segmentectomy and did not have VPI (71 [65.7%] vs. 79 [71.0%]; P = .36).
A lobectomy was not associated with improved survival as compared to patients who underwent a segmentectomy in patients with early-stage NSCLC with VPI. VPI remains a poor prognostic factor for survival regardless of the procedure performed. This data would indicate that the presence of VPI should not be a determining factor in the anatomic lung resection selected in patients with small, early-stage NSCLC.
本研究旨在利用具有代表性的全国样本，比较接受肺叶切除术或肺段切除术的伴有脏层胸膜侵犯（VPI）患者的生存结果。
使用2010年至2019年的国家癌症数据库。纳入肿瘤大小≤2 cm、伴有VPI、非小细胞肺癌（NSCLC）且已知生存状态的患者。进行倾向匹配分析，以比较接受肺叶切除术或肺段切除术的VPI患者。
在符合纳入标准的66181例患者中，6575例（9.9%）伴有VPI。在匹配后分析中，伴有VPI且接受肺叶切除术或肺段切除术的患者5年生存率无显著差异（76例[77.1%]对71例[65.7%]；P = 0.23）。与接受肺叶切除术但无VPI的患者相比，伴有VPI且接受肺叶切除术的患者5年生存率较差（1154例[73.7%]对1240例[78.5%]；P < 0.001）。接受肺段切除术且伴有VPI的患者与接受肺段切除术但无VPI的患者5年生存率无差异（71例[65.7%]对79例[71.0%]；P = 0.36）。
在伴有VPI的早期NSCLC患者中，与接受肺段切除术的患者相比，肺叶切除术与生存率改善无关。无论采用何种手术方式，VPI仍然是生存的不良预后因素。该数据表明，VPI的存在不应成为小的早期NSCLC患者选择肺解剖切除术的决定因素。
