Li Zhenjie, Wang Zhi, Wang Silin, Wu Longren, Xiong Linmin, Hu Zijian, Ruan Liancheng, Zhu Lingxiao, Luo Shengbai, Wei Yiping, Yu Dongliang
Department of Thoracic Surgery, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
J Thorac Dis. 2025 Jun 30;17(6):3783-3796. doi: 10.21037/jtd-2024-2247. Epub 2025 Jun 26.
The optimal surgical approach for treating stage I second primary lung cancer (SPLC) in elderly patients with a history of lobar resection remains uncertain. To address this knowledge gap, we conducted a comparative analysis of lobar resection versus sublobar resection outcomes in elderly patients diagnosed with contralateral stage I SPLC, utilizing population-based databases.
We identified elderly patients diagnosed with T1-2N0M0 SPLC from the Surveillance, Epidemiology, and End Results (SEER) database (2008-2015) who had undergone prior lobar resection for their first primary lung cancer. To ensure accurate classification of SPLC, we applied the Martini and Melamed criteria, which distinguish multiple primary lung cancers based on histologic and anatomic features. Survival outcomes were compared using Kaplan-Meier analysis and multivariable Cox proportional hazards regression. To mitigate potential confounding factors, we constructed a matched cohort through propensity score matching (PSM), balancing baseline characteristics between the lobar and sublobar resection groups.
A total of 373 patients met the inclusion criteria, comprising 253 in the sublobar resection group and 120 in the lobar resection group. Following PSM, 297 patients were retained for analysis. The analysis revealed that sublobar resection was associated with significantly improved overall survival (OS) compared to lobar resection in elderly patients with contralateral SPLC, with 5-year OS rates of 43.4% versus 34.3% (P=0.03).
For elderly patients with contralateral SPLC, sublobar resection is better than lobar resection.
对于有肺叶切除史的老年患者，治疗Ⅰ期第二原发性肺癌（SPLC）的最佳手术方式仍不确定。为填补这一知识空白，我们利用基于人群的数据库，对诊断为对侧Ⅰ期SPLC的老年患者行肺叶切除与肺段切除的结果进行了对比分析。
我们从监测、流行病学和最终结果（SEER）数据库（2008 - 2015年）中识别出诊断为T1 - 2N0M0 SPLC且曾因第一原发性肺癌接受过肺叶切除的老年患者。为确保SPLC的准确分类，我们应用了Martini和Melamed标准，该标准根据组织学和解剖学特征区分多个原发性肺癌。使用Kaplan - Meier分析和多变量Cox比例风险回归比较生存结果。为减轻潜在的混杂因素，我们通过倾向评分匹配（PSM）构建了一个匹配队列，平衡肺叶切除组和肺段切除组之间的基线特征。
共有373例患者符合纳入标准，其中肺段切除组253例，肺叶切除组120例。PSM后，保留297例患者进行分析。分析显示，在对侧SPLC的老年患者中，与肺叶切除相比，肺段切除与显著改善的总生存期（OS）相关，5年OS率分别为43.4%和34.3%（P = 0.03）。
对于对侧SPLC的老年患者，肺段切除优于肺叶切除。
