Eisenberg Michael A, Werner Raphael, Ries Shanique, Hofstetter Wayne L, Mehran Reza J, Papasotiropoulos Theodorus, Rice David C, Rajaram Ravi, Steinmann Nina, Swisher Stephen G, Walsh Garrett L, Vaporciyan Ara A, Opitz Isabelle, Antonoff Mara B
Department of Thoracic Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex.
Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
J Thorac Cardiovasc Surg. 2025 Aug;170(2):359-368.e3. doi: 10.1016/j.jtcvs.2025.04.027. Epub 2025 Apr 23.
The benefits of pulmonary resection as local consolidative therapy for stage IV non-small cell lung cancer (NSCLC) have been clearly demonstrated in appropriate patients. For early-stage disease, debate continues regarding the role of anatomic versus parenchymal-sparing resection. We explored the impact of resection extent on outcomes for stage IV NSCLC.
Patients were identified from 2 thoracic surgery departments. Included patients underwent pulmonary resection for stage IV NSCLC between 1996 and 2023. Resection extent was categorized as sublobar, lobar, or greater than lobar. The primary outcome was development of locoregional recurrence (adjacent to the surgical margin, ipsilateral hemithorax, or regional lymph nodes). A multivariable binomial logistic regression was performed for locoregional recurrence. Kaplan-Meier analyses evaluated survival outcomes.
In total, 179 patients were included, with mean age of 58.8 years (interquartile range, 51.8-66.5 years). The mean number of metastases was 1.68 (interquartile range, 1.0-2.0). A total of 116 (64.8%) patients received neoadjuvant treatment, with 22 (12.3%) achieving complete response, and 31 (17.3%) patients underwent sublobar resection, 130 (72.6%) lobectomy, and 18 (10.1%) more extensive resections. Locoregional recurrence occurred in 24 (13.4%) patients, including 2 (6.4%) in the sublobar group, 20 (15.4%) lobectomy group, and 2 (11.1%) greater-than-lobectomy group. Extent of resection did not independently predict locoregional recurrence (sublobar resection odds ratio, 0.44, P = .30; greater than lobar odds ratio, 0.48, P = .51). Overall (P = .14) and progression-free survival (P = .35) were similar between groups.
Resection extent in stage IV NSCLC does not impact subsequent locoregional recurrence, highlighting the importance of identifying relevant guidelines for optimal oncologic outcomes in patients undergoing surgery for metastatic disease.
肺切除术作为局部巩固治疗手段对IV期非小细胞肺癌（NSCLC）患者的益处已在合适的患者中得到明确证实。对于早期疾病，关于解剖性切除与实质保留性切除的作用仍存在争议。我们探讨了切除范围对IV期NSCLC患者预后的影响。
从两个胸外科科室中筛选患者。纳入的患者在1996年至2023年间因IV期NSCLC接受了肺切除术。切除范围分为亚肺叶、肺叶或大于肺叶切除。主要结局是局部区域复发（手术切缘附近、同侧半胸或区域淋巴结）。对局部区域复发进行多变量二项逻辑回归分析。采用Kaplan-Meier分析评估生存结局。
共纳入179例患者，平均年龄58.8岁（四分位间距为51.8 - 66.5岁）。转移灶的平均数量为1.68个（四分位间距为1.0 - 2.0个）。共有116例（64.8%）患者接受了新辅助治疗，其中22例（12.3%）达到完全缓解，31例（17.3%）患者接受了亚肺叶切除，130例（72.6%）接受了肺叶切除，18例（10.1%）接受了更广泛的切除。24例（13.4%）患者发生局部区域复发，其中亚肺叶切除组2例（6.4%），肺叶切除组20例（15.4%），大于肺叶切除组2例（11.1%）。切除范围并不能独立预测局部区域复发（亚肺叶切除的比值比为0.44，P = 0.30；大于肺叶切除的比值比为0.48，P = 0.51）。各组间总生存（P = 0.14）和无进展生存（P = 0.35）相似。
IV期NSCLC的切除范围不影响随后的局部区域复发，这凸显了为转移性疾病手术患者确定最佳肿瘤学结局相关指南的重要性。
