Zhou Shengzhe, Zhu Shusheng, Li Zhihua, He Zhicheng, Xu Wenzheng, Pan Xianglong, Wu Weibing, Chen Liang
Department of Thoracic Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of Thoracic Surgery, Taizhou Hospital of Traditional Chinese Medicine, Taizhou, China.
Eur J Surg Oncol. 2025 Apr 12;51(8):110051. doi: 10.1016/j.ejso.2025.110051.
Intersegmental non-small cell lung cancer (NSCLC) represents a type of lesion involving at least two segments. This study aimed to demonstrate the characteristics of intersegmental NSCLC and compare the prognosis of segmentectomy with lobectomy for intersegmental NSCLC.
A retrospective study was conducted on patients with small-sized NSCLC who underwent segmentectomy or lobectomy between January 2012 and December 2020. Intersegmental and non-intersegmental nodules were determined by three-dimensional computed tomographic bronchography and angiography. The log-rank test and Cox hazard proportional regression were adopted for prognostic analyses.
Totally, 1702 patients with 425 intersegmental nodules (25 %) and 1277 non-intersegmental nodules (75 %) were enrolled. Among eligible patients, 1086 patients accepted segmentectomy (intersegmental n = 188, non-intersegmental n = 898) and 616 patients underwent lobectomy (intersegmental n = 237, non-intersegmental n = 379). Intersegmental nodules were associated with larger tumor size and more lymph node metastasis (5.4 % vs. 2.1 %, P = 0.001), while intersegmental NSCLC achieved a similar prognosis to non-intersegmental NSCLC. Segmentectomy for intersegmental nodules required longer operative times, resection of more subsegments (4.06 vs. 2.91, P < 0.001), and larger resected lung volumes compared to that for non-intersegmental nodules. For patients with intersegmental nodules, the lobectomy group had larger tumor sizes, more solid nodules, and more lymph node metastasis than the segmentectomy group. After propensity score-matching, segmentectomy (n = 75) yielded comparable 5-year overall survival and disease-free survival with the lobectomy (n = 75).
Intersegmental nodules demonstrate a prognosis similar to non-intersegmental nodules, despite showing a higher rate of lymph node metastasis. Segmentectomy achieved long-term outcomes comparable to lobectomy for selected intersegmental NSCLC.
节段间非小细胞肺癌（NSCLC）是一种累及至少两个肺段的病变类型。本研究旨在阐明节段间NSCLC的特征，并比较节段切除术与肺叶切除术治疗节段间NSCLC的预后。
对2012年1月至2020年12月期间接受节段切除术或肺叶切除术的小尺寸NSCLC患者进行回顾性研究。通过三维计算机断层扫描支气管造影和血管造影确定节段间和非节段间结节。采用对数秩检验和Cox风险比例回归进行预后分析。
共纳入1702例患者，其中节段间结节425个（25%），非节段间结节1277个（75%）。在符合条件的患者中，1086例患者接受了节段切除术（节段间188例，非节段间898例），616例患者接受了肺叶切除术（节段间237例，非节段间379例）。节段间结节与更大的肿瘤大小和更多的淋巴结转移相关（5.4%对2.1%，P = 0.001），而节段间NSCLC的预后与非节段间NSCLC相似。与非节段间结节相比，节段间结节的节段切除术需要更长的手术时间，切除更多的亚段（4.06对2.91，P < 0.001），切除的肺体积更大。对于节段间结节患者，肺叶切除术组的肿瘤尺寸更大，实性结节更多，淋巴结转移更多。倾向评分匹配后，节段切除术（n = 75）与肺叶切除术（n = 75）的5年总生存率和无病生存率相当。
节段间结节尽管淋巴结转移率较高，但其预后与非节段间结节相似。对于选定的节段间NSCLC，节段切除术取得了与肺叶切除术相当的长期疗效。
