Huang Lin, Brunelli Alessandro, Stefanou Demetrios, Zanfrini Edoardo, Donlagic Abid, Gonzalez Michel, Petersen René Horsleben
Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Thoracic Surgery, St James's University Hospital, Leeds, UK.
Interdiscip Cardiovasc Thorac Surg. 2025 Mar 5;40(3). doi: 10.1093/icvts/ivaf064.
This study aims to identify the feasibility of segmentectomy for clinical stage IA3 (cIA3) vs cIA1-2 non-small cell lung cancer (NSCLC).
We retrospectively analysed data of consecutive patients with segmentectomy for cIA NSCLC across three centres between January 2017 and December 2022. The stabilized inverse probability of treatment-weighting (IPTW) was employed to minimize potential confounding in baseline characteristics. Recurrence-free survival (RFS) differences were examined using Kaplan-Meier estimator with the log-rank test. The Cox regression model was applied to assess the average treatment effect (ATE) between two groups in RFS. Subgroup and sensitivity analyses were performed.
Of a total of 589 patients who underwent segmentectomy, 478 presented with cIA1-2 NSCLC while 111 presented with cIA3 NSCLC. In comparison with cIA1-2 cases, the cIA3 cohort were significantly older with poorer lung function and more comorbidity. The cIA3 NSCLC presented significantly invasive characteristics, with extensive tissues dissected. After median follow-up of 24.0 (interquartile range 12.5-40.1) months, we did not observe significant difference in RFS (3-year 73.4% vs 78.5%, P = 0.490; ATE: 1.17) between the cIA3 vs cIA1-2 groups. These findings were corroborated following the stabilized IPTW. Preoperative characteristics in the cIA3 subgroup were not related to RFS. In the sensitivity analysis, no difference in RFS was found between the two groups stratified by peripheral and central localization.
In well-selected patients with cIA3 NSCLC, segmentectomy leads to no statistical difference in oncologic outcomes compared to those observed in earlier stages in a relatively short follow-up period.
本研究旨在确定临床IA3期（cIA3）与cIA1-2期非小细胞肺癌（NSCLC）行肺段切除术的可行性。
我们回顾性分析了2017年1月至2022年12月期间三个中心连续接受cIA NSCLC肺段切除术患者的数据。采用稳定的治疗权重逆概率（IPTW）来最小化基线特征中的潜在混杂因素。使用Kaplan-Meier估计量和对数秩检验来检验无复发生存期（RFS）差异。应用Cox回归模型评估两组在RFS方面的平均治疗效果（ATE）。进行了亚组分析和敏感性分析。
在总共589例行肺段切除术的患者中，478例为cIA1-2期NSCLC，111例为cIA3期NSCLC。与cIA1-2期病例相比，cIA3组患者年龄显著更大，肺功能更差，合并症更多。cIA3期NSCLC表现出明显的侵袭性特征，切除的组织范围更广。在中位随访24.0（四分位间距12.5 - 40.1）个月后，我们未观察到cIA3组与cIA1-2组在RFS方面有显著差异（3年时分别为73.4%和78.5%，P = 0.490；ATE：1.17）。稳定的IPTW分析结果证实了这些发现。cIA3亚组的术前特征与RFS无关。在敏感性分析中，按外周和中央定位分层的两组在RFS方面未发现差异。
在精心挑选的cIA3期NSCLC患者中，在相对较短的随访期内，与早期患者相比，肺段切除术在肿瘤学结局方面无统计学差异。
