Abdallat Mohammad, Leo Rachel T, Sugarbaker Evert A, McAllister Miles, Xie Yue, Mazzola Emanuele, Silvestri Mia, Bueno Raphael, Jaklitsch Michael, Ugalde Paula, Swanson Scott J, Wiener Daniel
Brigham and Women's Hospital, Division of Thoracic Surgery.
Dana Farber Cancer Institute.
Ann Thorac Surg. 2025 Aug 8. doi: 10.1016/j.athoracsur.2025.07.020.
With widespread adoption of segmentectomy for early-stage non-small cell lung cancer (NSCLC), the need to convert segmentectomy to lobectomy for nodal disease comes into question. We aimed to determine whether extent of resection impacts overall survival or locoregional recurrence-free survival (LRFS) in patients with occult N1 NSCLC.
We identified patients who underwent segmentectomy or lobectomy for NSCLC and were upstaged from cN0 to pN1 in our prospective institutional database from 01/2006-01/2023. Patients receiving neoadjuvant treatment, or parenchymal resection beyond the segment(s) or lobe of interest were excluded. Propensity-score weighting was used to control for potential confounders. Overall survival and LRFS were evaluated using Kaplan-Meier curves and compared with log-rank tests. Cox proportional hazards regression was used to calculate hazard ratios.
Of 185 patients with occult N1 disease: 30 (16.2%) underwent segmentectomy and 155 (83.8%) lobectomy. Patients undergoing lobectomy had larger pathological tumor sizes than those undergoing segmentectomy (3.4cm [IQR:2.30-4.45] vs. 1.95cm [1.43-2.83], p<0.005). There was no difference in rates of adjuvant therapy between segmentectomy and lobectomy (67% vs. 70%, p=0.7). Median follow-up was 60 months. There were no differences in 5-year survival or LRFS between segmentectomy and lobectomy before or after propensity weighting (weighted overall survival:79.69% vs. 66.22%, log-rank p=0.401). In multivariable analysis of survival and recurrence, procedure type was not a predictor of outcome.
Segmentectomy is associated with similar overall survival and LRFS to lobectomy for patients with occult N1 NSCLC.
随着肺段切除术在早期非小细胞肺癌（NSCLC）中的广泛应用，对于因淋巴结疾病而将肺段切除术转换为肺叶切除术的需求引发了质疑。我们旨在确定切除范围是否会影响隐匿性N1期NSCLC患者的总生存期或无局部区域复发生存期（LRFS）。
我们在2006年1月至2023年1月的前瞻性机构数据库中，识别出因NSCLC接受肺段切除术或肺叶切除术且分期从cN0上调至pN1的患者。排除接受新辅助治疗或切除感兴趣的肺段或肺叶以外的实质组织的患者。采用倾向得分加权法控制潜在混杂因素。使用Kaplan-Meier曲线评估总生存期和LRFS，并通过对数秩检验进行比较。采用Cox比例风险回归计算风险比。
在185例隐匿性N1期疾病患者中，30例（16.2%）接受了肺段切除术，155例（83.8%）接受了肺叶切除术。接受肺叶切除术的患者病理肿瘤大小大于接受肺段切除术的患者（3.4cm[四分位间距：2.30 - 4.45] vs. 1.95cm[1.43 - 2.83]，p<0.005）。肺段切除术和肺叶切除术的辅助治疗率无差异（67% vs. 70%，p = 0.7）。中位随访时间为60个月。在倾向加权前后，肺段切除术和肺叶切除术的5年生存率或LRFS均无差异（加权总生存期：79.69% vs. 66.22%，对数秩p = 0.401）。在生存和复发的多变量分析中，手术类型不是预后的预测因素。
对于隐匿性N1期NSCLC患者，肺段切除术与肺叶切除术的总生存期和LRFS相似。
