Ryuko Tsuyoshi, Okazaki Mikio, Mitsuhashi Toshiharu, Suzawa Ken, Shien Kazuhiko, Ueno Tsuyoshi, Fujiwara Toshiya, Watanabe Mototsugu, Inokawa Hidetoshi, Misao Takahiko, Torigoe Hidejiro, Washio Kazuhiro, Tao Hiroyuki, Okutani Daisuke, Hayama Makio, Uomoto Masashi, Yamada Eiji, Otani Shinji, Kurosaki Takeshi, Yaginuma Yuji, Niman Eito, Kawamata Osamu, Nishikawa Hitoshi, Otsuka Tomoaki, Yoshikawa Takeshi, Hayashi Tatsuro, Toyooka Shinichi
Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Okayama University Thoracic Surgery Study Group, Okayama, Japan.
Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Okayama University Thoracic Surgery Study Group, Okayama, Japan.
Ann Thorac Surg. 2025 Jul;120(1):87-98. doi: 10.1016/j.athoracsur.2025.02.023. Epub 2025 Mar 20.
Segmentectomy for lung cancer has been increasingly performed. However, evidence regarding the necessity of additional surgical resection after the diagnosis of unsuspected N1 or N2 lymph node metastasis is limited.
We conducted a multicenter, real-world data study of patients with any clinical T and N0 non-small cell lung cancer (NSCLC) who underwent lobectomy or segmentectomy between 2012 and 2021 and who subsequently received a diagnosis of pathologic N1 or N2 lymph node metastasis. Patients were categorized into lobectomy and segmentectomy groups. We analyzed overall survival (OS), recurrence-free survival (RFS), cumulative recurrence rates, and recurrence patterns using both unadjusted and propensity score-adjusted cohorts.
A total of 736 patients were in the lobectomy group, and 70 were in the segmentectomy group. In the unadjusted cohort, segmentectomy-treated patients were older, had a lower preoperative percentage of vital capacity, had smaller tumors, and received less postoperative adjuvant chemotherapy. The 5-year OS was significantly worse in the segmentectomy group (P = .011), with no significant differences in 5-year RFS or cumulative recurrence rates. In the propensity score-adjusted cohort, there were no significant differences in OS, RFS, or recurrence rates; however, the segmentectomy group had a higher rate of local recurrence.
In patients with unsuspected N1 or N2 NSCLC, analysis using a cohort adjusted for patient background with propensity scores revealed no differences in OS, RFS, or cumulative recurrence rates between segmentectomy and lobectomy. This finding suggests that additional resection of the remaining segments may not be necessary for these patients. However, the higher rate of local recurrence in the segmentectomy group warrants careful consideration.
肺癌肺段切除术的应用越来越广泛。然而，关于在诊断出意外的N1或N2淋巴结转移后是否有必要进行额外手术切除的证据有限。
我们对2012年至2021年间接受肺叶切除术或肺段切除术且随后被诊断为病理N1或N2淋巴结转移的任何临床分期T且N0的非小细胞肺癌（NSCLC）患者进行了一项多中心、真实世界数据研究。患者被分为肺叶切除术组和肺段切除术组。我们使用未调整队列和倾向评分调整队列分析了总生存期（OS）、无复发生存期（RFS）、累积复发率和复发模式。
肺叶切除术组共有736例患者，肺段切除术组有70例患者。在未调整队列中，接受肺段切除术治疗的患者年龄较大，术前肺活量百分比较低，肿瘤较小，术后接受辅助化疗的比例较低。肺段切除术组的5年总生存期明显更差（P = 0.011），5年无复发生存期或累积复发率无显著差异。在倾向评分调整队列中，总生存期、无复发生存期或复发率无显著差异；然而，肺段切除术组的局部复发率较高。
在意外发生N1或N2期非小细胞肺癌的患者中，使用倾向评分调整患者背景的队列分析显示，肺段切除术和肺叶切除术在总生存期、无复发生存期或累积复发率方面没有差异。这一发现表明，这些患者可能无需对剩余肺段进行额外切除。然而，肺段切除术组较高的局部复发率值得仔细考虑。
