Huang Lin, Brunelli Alessandro, Stefanou Demetrios, Zanfrini Edoardo, Donlagic Abid, Gonzalez Michel, Petersen René Horsleben
Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK.
Surg Endosc. 2025 Apr;39(4):2296-2303. doi: 10.1007/s00464-025-11612-9. Epub 2025 Feb 13.
The study aimed to evaluate the risk of unforeseen nodal upstaging (pN+) after pulmonary segmentectomy without intraoperative frozen section.
We conducted a retrospective analysis for consecutive patients who underwent segmentectomy for clinical stage IA1-2 non-small cell lung cancer (cIA1-2 NSCLC) in three centers between January 2017 and December 2022. A backward stepwise logistic regression analysis for variables with P < 0.1 in univariable analysis was performed to predict pN+. Kaplan-Meier analysis with log-rank test evaluated the discrepancy for overall (OS) and recurrence-free survivals (RFS).
Among 478 patients included in the final analysis, 19 (4.0%) had pN+, including 10 (2.1%) pN1, 6 (1.3%) pN2, and 3 (0.6%) pN1+2. With a median follow-up of 23.5 months (interquartile range 12.6-39.0), patients with pN+ had poorer OS compared to those with pN0 (3-year OS: 70.2% vs. 89.7%, P = 0.002). However, there was no significant difference in RFS and recurrence. The maximum standardized uptake value (SUVmax) of tumor in positron emission tomography scan ≥ 4.5 (versus < 4.5) was the only independent factor for pN + (odds ratio 3.5). Patients with a SUVmax ≥ 4.5 had 7.3% pN+, which was associated with poorer OS and similar RFS and recurrence compared to pN0. In contrast, those with a SUVmax < 4.5 had 2.2% pN+, which had comparable recurrence and survival to pN0.
Unforeseen nodal upstaging in segmentectomy for cIA1-2 NSCLC is low. Frozen section of lymph nodes may be necessary for lesions with high metabolic activity.
本研究旨在评估在未进行术中冰冻切片的情况下，肺段切除术后意外出现淋巴结分期上调（pN+）的风险。
我们对2017年1月至2022年12月期间在三个中心接受临床IA1-2期非小细胞肺癌（cIA1-2 NSCLC）肺段切除术的连续患者进行了回顾性分析。对单因素分析中P<0.1的变量进行向后逐步逻辑回归分析以预测pN+。采用Kaplan-Meier分析和对数秩检验评估总生存期（OS）和无复发生存期（RFS）的差异。
在最终分析纳入的478例患者中，19例（4.0%）出现pN+，其中10例（2.1%）为pN1，6例（1.3%）为pN2，3例（0.6%）为pN1+2。中位随访时间为23.5个月（四分位间距12.6 - 39.0），pN+患者的OS较pN0患者差（3年OS：70.2%对89.7%，P = 0.002）。然而，RFS和复发方面无显著差异。正电子发射断层扫描中肿瘤的最大标准化摄取值（SUVmax）≥4.5（对比<4.5）是pN+的唯一独立因素（比值比3.5）。SUVmax≥4.5的患者pN+发生率为7.3%，与pN0相比，其OS较差，RFS和复发情况相似。相比之下SUVmax<4.5的患者pN+发生率为2.2%，其复发和生存情况与pN0相当。
cIA1-2 NSCLC肺段切除术中意外出现淋巴结分期上调的情况较少。对于具有高代谢活性的病变，可能需要进行淋巴结冰冻切片检查。
