Akamine Takaki, Wakasu Sho, Matsubara Taichi, Yamaguchi Masafumi, Yamazaki Koji, Hamatake Motoharu, Kometani Takuro, Kinoshita Fumihiko, Kohno Mikihiro, Shimokawa Mototsugu, Takenaka Tomoyoshi, Yoshizumi Tomoharu
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Thoracic Surgery, NHO Kyushu Medical Center, Fukuoka, Japan.
Ann Surg Oncol. 2025 Jun;32(6):4161-4172. doi: 10.1245/s10434-024-16700-z. Epub 2024 Dec 16.
Sublobar resection is the standard procedure for cT1N0 stage I non-small cell lung cancer (NSCLC) size ≤2 cm. However, its efficacy for high-risk pathologic stage I cases with a preoperative diagnosis of cT1N0 stage I NSCLC size ≤2 cm remains unclear. This study compared the outcomes of sublobar resection with those of lobectomy from a pathologic perspective.
A multicenter retrospective analysis of patients with pathologic stage I NSCLC was performed following the eighth edition of tumor-node-metastasis (TNM) classification. The study enrolled patients with completely resected clinical stage I NSCLC and a tumor size of ≤2 cm determined by computed tomography. High-risk pathologic feature was defined as evidence of pleural invasion, lymphovascular invasion, or invasive component (>2 cm). Survival rates were compared between the patients who underwent sublobar resection and those who underwent lobectomy.
The study enrolled 875 patients (715 [81.7%] low-risk and 160 [18.3%] high-risk NSCLC patients). The high-risk patients in the lobectomy group had significantly better 5-year recurrence-free survival (RFS), overall survival (OS), and cancer-specific survival (CSS) rates than those in the sublobar resection group (RFS: 80.5% vs 44.3% [P < 0.001], OS: 84.9% vs 54.6% [P = 0.001], CSS: 91.6% vs 72.4% [P = 0.019]). In the low-risk group, lobectomy and sublobar resection resulted in equivalent 5-year RFS, OS, and CSS (RFS: 92.8% vs 88.6% [P = 0.13], OS: 93.8% vs 91.7% [P = 0.26], CSS: 98.9% vs 98.4% [P = 0.67]). Multivariate analysis indicated that sublobar resection was independently associated with poor RFS, OS, and CSS for the high-risk patients.
Sublobar resection is feasible for low-risk pathologic stage I NSCLC, whereas lobectomy may have a prognostic benefit for high-risk NSCLC.
肺叶下切除是cT1N0期I期非小细胞肺癌（NSCLC）且肿瘤大小≤2 cm的标准手术方式。然而，其对于术前诊断为cT1N0期I期NSCLC且肿瘤大小≤2 cm的高危病理I期病例的疗效仍不明确。本研究从病理角度比较了肺叶下切除与肺叶切除的疗效。
按照第八版肿瘤-淋巴结-转移（TNM）分类对病理I期NSCLC患者进行多中心回顾性分析。本研究纳入了经计算机断层扫描确定为临床I期NSCLC且肿瘤大小≤2 cm且已完全切除的患者。高危病理特征定义为存在胸膜侵犯、脉管侵犯或浸润成分（>2 cm）。比较接受肺叶下切除的患者与接受肺叶切除的患者的生存率。
本研究纳入了875例患者（715例[81.7%]低危和160例[18.3%]高危NSCLC患者）。肺叶切除组的高危患者的5年无复发生存率（RFS）、总生存率（OS）和癌症特异性生存率（CSS）显著高于肺叶下切除组（RFS：80.5%对44.3%[P<0.001]，OS：84.9%对54.6%[P = 0.001]，CSS：91.6%对72.4%[P = 0.019]）。在低危组中，肺叶切除和肺叶下切除的5年RFS、OS和CSS相当（RFS：92.8%对88.6%[P = 0.13]，OS：93.8%对91.7%[P = 0.26]，CSS：98.9%对98.4%[P = 0.67]）。多因素分析表明，肺叶下切除与高危患者较差的RFS、OS和CSS独立相关。
肺叶下切除对于低危病理I期NSCLC是可行的，而肺叶切除可能对高危NSCLC有预后益处。
