Pan Hanbo, Chen Hang, Kong Weicheng, Ge Zhen, Zhang Jiaqi, Li Wanyu, Tian Yu, Ning Junwei, Fang Liang, Dai Zhizhuo, Ruan Guomo, Chen Zhongjie, Zheng Min, Wang Hui, Zhang Ming, Li Ziming, Huang Jia, Zhou Chengwei, Xu Guodong, Yin Hui, Luo Qingquan
Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 Huaihai West Road, Shanghai, 200030, China.
Department of Cardiothoracic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315040, China.
Updates Surg. 2025 Jun 21. doi: 10.1007/s13304-025-02289-9.
Tumor spread through air spaces (STAS) is an important prognostic factor for lung cancer, including lung neuroendocrine tumors (NETs). The comparative oncological efficacy of lobar resection (LR) and sub-lobar resection (SR) for clinical stage IA (cIA) STAS-positive NETs remains unclear. This retrospective study aimed to review outcomes in patients with consecutive peripheral cIA (tumors ≤ 2 cm) STAS-positive NET patients (excluding small cell lung cancer) who underwent surgery between 2012 and 2020 at six high-volume tertiary Chinese institutions. SR was commonly performed for patients ineligible for LR for various reasons. The primary endpoint was recurrence-free survival (RFS), while the secondary endpoint was overall survival (OS). Propensity score matching (PSM) was utilized to minimize selection bias. Among the 599 eligible patients, PSM resulted in 328 LR and 164 SR cases with well-balanced baseline characteristics. During a median follow-up of 6.8 years, LR significantly improved 5-year RFS (68.3% versus 54.3%, hazard ratio (HR) [95% confidence interval (CI)] = 0.595 [0.449-0.787], P < 0.001) and OS (79.0% versus 72.6%, HR [95%CI] = 0.650 [0.484-0.872], P = 0.025), and reduced postoperative recurrence (34.5% versus 51.2%, P < 0.001) and mortality (32.3% versus 46.3%, P = 0.002) rates compared to SR. Subgroup analysis revealed that LR improved RFS (59.2% versus 42.5%, HR [95%CI] = 0.553 [0.408-0.749], P < 0.001) and OS (74.0% versus 63.7%, HR [95%CI] = 0.710 [0.509-0.989], P = 0.043) compared to SR in patients with large cell neuroendocrine carcinoma (LCNEC), while both approaches yielded comparable prognoses in patients with carcinoid. Furthermore, segmentectomy exhibited survival outcomes comparable to those of wedge resection. Collectively, LR demonstrated better survival outcomes than SR for cIA STAS-positive NETs, with the benefit being influenced by the tumor histology. LCNEC was associated with a 3.3-fold higher risk of recurrence and a 4.0-fold higher risk of mortality than carcinoid.
肿瘤通过气腔播散（STAS）是肺癌（包括肺神经内分泌肿瘤（NETs））的一个重要预后因素。肺叶切除术（LR）和肺段以下切除术（SR）对临床IA期（cIA）STAS阳性NETs的相对肿瘤学疗效仍不清楚。这项回顾性研究旨在回顾2012年至2020年期间在中国六家大型三级医疗机构接受手术的连续外周cIA期（肿瘤≤2 cm）STAS阳性NET患者（不包括小细胞肺癌）的预后。由于各种原因不符合LR条件的患者通常进行SR。主要终点是无复发生存期（RFS），次要终点是总生存期（OS）。采用倾向评分匹配（PSM）以尽量减少选择偏倚。在599例符合条件的患者中，PSM产生了328例LR和164例SR病例，基线特征良好平衡。在中位随访6.8年期间，与SR相比，LR显著改善了5年RFS（68.3%对54.3%，风险比（HR）[95%置信区间（CI）]=0.595[0.449 - 0.787]，P<0.001）和OS（79.0%对72.6%，HR[95%CI]=0.650[0.484 - 0.872]，P = 0.025），并降低了术后复发率（34.5%对51.2%，P<0.001）和死亡率（32.3%对46.3%，P = 0.002）。亚组分析显示，与SR相比，LR改善了大细胞神经内分泌癌（LCNEC）患者的RFS（59.2%对42.5%，HR[95%CI]=0.553[0.408 - 0.749]，P<0.001）和OS（74.0%对63.7%，HR[95%CI]=0.710[0.509 - 0.989]，P = 0.043），而两种方法在类癌患者中产生的预后相当。此外，肺段切除术的生存结果与楔形切除术相当。总体而言，对于cIA STAS阳性NETs，LR的生存结果优于SR，其益处受肿瘤组织学影响。与类癌相比，LCNEC的复发风险高3.3倍，死亡风险高4.0倍。
