手术中意外发现有胸膜播散的非小细胞肺癌患者的原发肿瘤切除术：一项双中心回顾性队列研究

Primary tumour resection in non-small cell lung cancer patients with pleural dissemination unexpectedly detected during operation: a two-centre retrospective cohort study.

作者信息

Bao Tao, Deng Yuanlin, Chen Liang, Sun Weijie, Ge Mingjian, Zhao Xiaolong, Chen Xu, Zhang Liang, Wang Yingjian, He Xiandong, Pu Xiangshu, He Yan, Yu Jun, Guo Wei

机构信息

Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, China.

Department of Thoracic Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China.

出版信息

BMC Cancer. 2025 Feb 21;25(1):316. doi: 10.1186/s12885-025-13747-3.

DOI:10.1186/s12885-025-13747-3

PMID:39984876

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11844075/

Abstract

BACKGROUND

There is no consensus regarding whether primary tumour resection (PTR) should be performed in non-small cell lung cancer (NSCLC) patients with unexpected pleural dissemination (PD) discovered at thoracotomy.

MATERIALS AND METHODS

Consecutive NSCLC patients with surgically confirmed PD were retrospectively enrolled from two high-volume centres between January 2016 and December 2023. Patients were divided into the primary tumour resection (PTR) and exploratory thoracotomy (ET) group. PTR included wedge resection, segmentectomy and lobectomy. Patients in the ET group received biopsy only. Propensity score matching (PSM) was used to reduce selection bias from confounding factors. Disease-specific survival (DSS) and progression-free survival (PFS) were analysed using the Kaplan‒Meier method, and comparisons were made using the log-rank test. Multivariate Cox regression analyses were performed to identify the independent prognostic factors.

RESULTS

A total of 223 patients were identified: 167 (74.9%) in the PTR group and 56 (25.1%) in the ET group. The median follow-up time and median survival time (MST) were 39.0 months and 49.0 months, respectively. The MST for the ET and PTR groups were 44.0 and 60.0 months, respectively (HR 0.80, 95% CI 0.51-1.24; p = 0.3097). After PSM, there were no significant differences in terms of median disease-specific survival (DSS: 60.0 vs. 61.0 months, p = 0.3419) or progression-free survival (PFS: 30.0 vs. 47.0 months, p = 0.5471) between the two groups. Multivariate analysis revealed that smoking history and a tumour size ≥ 3 cm were independent risk factors for DSS and PFS, whereas targeted therapy was an independent protective factor.

CONCLUSION

Our results suggest that primary tumour resection does not improve long-term survival in NSCLC patients with unexpected PD discovered at thoracotomy. It is high time to re-evaluate the value of surgery for NSCLC patients with PD and avoid overtreatment, especially in the era of targeted therapy and immunotherapy.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06232967 (approval date: January 31, 2024).

摘要

背景

对于在开胸手术中发现意外胸膜播散（PD）的非小细胞肺癌（NSCLC）患者是否应进行原发肿瘤切除术（PTR），目前尚无共识。

材料与方法

回顾性纳入2016年1月至2023年12月期间来自两个大型中心的经手术确诊为PD的连续NSCLC患者。患者分为原发肿瘤切除术（PTR）组和 exploratory thoracotomy（ET）组。PTR包括楔形切除术、肺段切除术和肺叶切除术。ET组患者仅接受活检。采用倾向评分匹配（PSM）以减少混杂因素造成的选择偏倚。采用Kaplan-Meier法分析疾病特异性生存（DSS）和无进展生存（PFS），并使用对数秩检验进行比较。进行多因素Cox回归分析以确定独立预后因素。

结果

共纳入223例患者：PTR组167例（74.9%），ET组56例（25.1%）。中位随访时间和中位生存时间（MST）分别为39.0个月和49.0个月。ET组和PTR组的MST分别为44.0个月和60.0个月（风险比0.80，95%置信区间0.51-1.24；p = 0.3097）。PSM后，两组间的中位疾病特异性生存（DSS：60.0对61.0个月，p = 0.3419）或无进展生存（PFS：30.0对47.0个月，p = 0.5471）无显著差异。多因素分析显示，吸烟史和肿瘤大小≥3 cm是DSS和PFS的独立危险因素，而靶向治疗是独立保护因素。