Wada Hironobu, Suzuki Hidemi, Toyoda Takahide, Sata Yuki, Inage Terunaga, Tanaka Kazuhisa, Sakairi Yuichi, Matsui Yukiko, Yoshida Shigetoshi, Yoshino Ichiro
Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
Department of Thoracic Surgery, International University of Health and Welfare School of Medicine, Narita, Japan.
J Thorac Dis. 2024 Nov 30;16(11):7511-7525. doi: 10.21037/jtd-24-783. Epub 2024 Nov 22.
Segmentectomy has been recognized as the standard procedure for small peripheral lung cancer; however, it has been shown that loco-regional relapse is more common with segmentectomy than with lobectomy. This study aims to investigate the long-term outcomes and loco-regional relapse patterns in patients with clinical stage IA (c-IA) non-small cell lung cancer (NSCLC) after segmentectomy and compare them with those after lobectomy.
We retrospectively compared the long-term outcomes of 115 patients who underwent segmentectomy for c-IA NSCLC with those of 292 patients who underwent lobectomy between January 2008 and December 2015. Segmentectomy was indicated intentionally or chosen in patients who were considered intolerable to lobectomy. New isolated growing lung lesions were defined as relapses if they were not diagnosed with a second primary lung cancer.
The median observation period was 2,150 days. The 10-year overall survival (OS) rates and relapse-free survival (RFS) rates of the two groups were similar: 79.4% and 68.7% for segmentectomy, and 68.2% and 61.2% for lobectomy. Even after propensity score matching, no significant differences were observed in the OS and RFS rates between the groups. The segmentectomy group had a higher loco-regional relapse rate (14% . 8%), including the surgical margin, remnant lobe, ipsilateral lung, mediastinal lymph node, and ipsilateral dissemination; however, no relapse was observed in the ipsilateral hilar lymph node. Loco-regional relapse occurred significantly later after segmentectomy than after lobectomy (median: 1,246 . 512 days, P=0.03), especially four years after segmentectomy. Loco-regional relapse occurred even when the tumor diameter was <1.0 cm. Most patients with loco-regional relapse had solid-dominant tumors.
Segmentectomy, both intentional and compromised, showed comparable long-term outcomes to lobectomy; however, loco-regional relapse can develop in a later phase than lobectomy, requiring careful follow-up.
肺段切除术已被公认为治疗周围型小肺癌的标准术式；然而，研究表明，与肺叶切除术相比，肺段切除术局部区域复发更为常见。本研究旨在调查临床ⅠA期（c-ⅠA）非小细胞肺癌（NSCLC）患者行肺段切除术后的长期预后及局部区域复发模式，并与肺叶切除术后的情况进行比较。
我们回顾性比较了2008年1月至2015年12月期间115例行c-ⅠA期NSCLC肺段切除术患者与292例行肺叶切除术患者的长期预后。肺段切除术是有意实施的，或是在被认为无法耐受肺叶切除术的患者中选择的。新出现的孤立性生长性肺病灶若未被诊断为第二原发性肺癌，则定义为复发。
中位观察期为2150天。两组的10年总生存率（OS）和无复发生存率（RFS）相似：肺段切除术组分别为79.4%和68.7%，肺叶切除术组分别为68.2%和61.2%。即使在倾向评分匹配后，两组之间的OS和RFS率也未观察到显著差异。肺段切除术组的局部区域复发率较高（14%对8%），包括手术切缘、余肺叶、同侧肺、纵隔淋巴结和同侧播散；然而，同侧肺门淋巴结未观察到复发。肺段切除术后局部区域复发明显晚于肺叶切除术后（中位时间：1246天对512天，P = 0.03），尤其是肺段切除术后四年。即使肿瘤直径<1.0 cm时也会发生局部区域复发。大多数局部区域复发的患者为实性为主型肿瘤。
无论是有意还是不得已而实施的肺段切除术，其长期预后与肺叶切除术相当；然而，局部区域复发可能比肺叶切除术发生得更晚，需要密切随访。
