Zimmermann Julia, Walter Julia, Pfeiffer Valentina, Kovács Julia, Yavuz Gökçe, Schön Johannes, Stoleriu Mircea Gabriel, Ketscher Christian, Reinmuth Niels, Hatz Rudolf A, Tufman Amanda, Schneider Christian P
Division of Thoracic Surgery, LMU University Hospital, LMU Munich and Asklepios Lung Clinic, Gauting, Germany.
Division of Thoracic Surgery, Ludwig-Maximilians-University, Marchionini Street 15, 81377, Munich, Germany.
J Cardiothorac Surg. 2025 Jan 27;20(1):96. doi: 10.1186/s13019-025-03346-5.
Lymph node upstaging represents a quality criterion for standardized lymphadenectomy in lung cancer surgery. The aim of the study was to compare whether the quality of standardized lymphadenectomy in lung cancer surgery is comparable in minimally invasive (video-assisted thoracoscopic surgery) and the open approach (thoracotomy). Furthermore, factors associated with lymph node upstaging were assessed, as was its impact on overall survival and progression-free survival.
This retrospective study reviewed data of all patients undergoing lobectomy at the Lung Tumor Center Munich between 2011 and 2020. Inclusion factors were non-small cell lung cancer without nodal involvement (N0) or metastasis (M0) and standardized lymphadenectomy. A propensity score matched analyses was performed. Frequency of categorical outcomes was compared with Chi [2]-test, mean values with t-test. We used logistic and Cox regression models to assess factors associated with upstaging, overall survival and progression-free survival, restrictively.
Of 1691 patients undergoing lobectomy, 637 met our inclusion criteria. After propensity score matching 198 patients remained in each group. Univariate analysis showed no significant difference in lymph node upstaging between the two groups. (p = 0.12). Overall affected lymph nodes (p = 0.45) and overall affected lymph node stations (p = 0.26) were not significantly different. Multivariate Cox regression analysis showed that overall survival and progression free survival were also independent of the surgical approach. L1 status was the only factor associated with progression-free survival.
Minimally invasive approaches achieves comparable lymph node upstaging in patients undergone standardized lymphadenectomy.
淋巴结分期上调是肺癌手术中标准化淋巴结清扫术的一项质量标准。本研究的目的是比较肺癌手术中标准化淋巴结清扫术在微创（电视辅助胸腔镜手术）和开放手术（开胸手术）中的质量是否可比。此外，评估了与淋巴结分期上调相关的因素及其对总生存期和无进展生存期的影响。
这项回顾性研究回顾了2011年至2020年间在慕尼黑肺肿瘤中心接受肺叶切除术的所有患者的数据。纳入因素为无淋巴结受累（N0）或转移（M0）的非小细胞肺癌以及标准化淋巴结清扫术。进行了倾向评分匹配分析。分类结果的频率采用卡方检验进行比较，均值采用t检验进行比较。我们使用逻辑回归和Cox回归模型来严格评估与分期上调、总生存期和无进展生存期相关的因素。
在1691例接受肺叶切除术的患者中，637例符合我们的纳入标准。倾向评分匹配后，每组各有198例患者。单因素分析显示两组之间在淋巴结分期上调方面无显著差异（p = 0.12）。总的受累淋巴结数量（p = 0.45）和总的受累淋巴结站数（p = 0.26）也无显著差异。多因素Cox回归分析显示，总生存期和无进展生存期也与手术方式无关。L1状态是与无进展生存期相关的唯一因素。
在接受标准化淋巴结清扫术的患者中，微创方法可实现相当的淋巴结分期上调。
