Caso Raul, Zhou Nanruoyi, Skovgard Matthew, Toumbacaris Nicolas, Tan Kay See, Adusumilli Prasad S, Bains Manjit S, Bott Matthew J, Downey Robert J, Huang James, Isbell James M, Molena Daniela, Park Bernard J, Rocco Gaetano, Rusch Valerie W, Sihag Smita, Jones David R, Gray Katherine D
Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
J Thorac Cardiovasc Surg. 2025 Aug 29. doi: 10.1016/j.jtcvs.2025.08.024.
To investigate disease-free survival (DFS) of sublobar resection versus lobectomy for stage IA non-small cell lung cancer (NSCLC) with preoperative high-risk features.
Data were abstracted from a prospective database to identify patients with clinical T1a-T1bN0M0 NSCLC (≤2 cm) who underwent lobectomy or sublobar resection (wedge resection or segmentectomy). 1:1 propensity matching was used to balance the dataset for forced expiratory volume in 1 second ≥60% and high-risk features: cT1b versus cT1a, standard uptake value of the primary tumor on positron emission tomography, solid versus subsolid tumor texture on computed tomography, and micropapillary/solid histology. The primary outcome was DFS.
In total, 825 patients met inclusion criteria: 52% (n = 426) patients underwent lobectomy and 48% (n = 399) of patients underwent sublobar resection (45% segmentectomy, 55% wedge resection). Lobectomy was associated with more preoperative high-risk features: cT1b (P < .001), greater standard uptake value (P < .001), solid tumor texture on computed tomography (P < .001), and micropapillary/solid histology (P < .001). In total, 660 patients were included in the matched analysis with all high-risk features balanced. Nodal upstaging (N1) was greater in patients who underwent lobectomy (9.1% vs 3.4%, P = .004). Five-year DFS (85% vs 74%, P = .12) was equivalent in the matched cohort. Lobectomy was protective for recurrence in the presence of 2 or greater high-risk features: sublobar resection patients with 2 high-risk features (hazard ratio, 1.77; 95% confidence interval, 1.13-2.76, P = .012) or 3-4 high-risk features (hazard ratio, 1.97; 95% confidence interval, 1.25-3.10, P = .004) had worse DFS.
Lobectomy should be considered over sublobar resection for stage IA NSCLC ≤2 cm in the presence of multiple high-risk features.
探讨对于具有术前高危特征的ⅠA期非小细胞肺癌（NSCLC），亚肺叶切除与肺叶切除的无病生存期（DFS）。
从一个前瞻性数据库中提取数据，以识别接受肺叶切除或亚肺叶切除（楔形切除或肺段切除）的临床T1a - T1bN0M0 NSCLC（≤2 cm）患者。采用1:1倾向评分匹配来平衡数据集，以确保一秒用力呼气量≥60%以及高危特征方面的均衡：cT1b与cT1a、正电子发射断层扫描上原发肿瘤的标准摄取值、计算机断层扫描上实性与亚实性肿瘤质地以及微乳头/实性组织学。主要结局为DFS。
总共825例患者符合纳入标准：52%（n = 426）的患者接受了肺叶切除，48%（n = 399）的患者接受了亚肺叶切除（45%为肺段切除，55%为楔形切除）。肺叶切除与更多的术前高危特征相关：cT1b（P <.001）、更高的标准摄取值（P <.001）、计算机断层扫描上的实性肿瘤质地（P <.001）以及微乳头/实性组织学（P <.001）。共有660例患者纳入匹配分析，所有高危特征均达到平衡。接受肺叶切除的患者中淋巴结分期上调（N1）更多（9.1%对3.4%，P =.004）。匹配队列中的五年DFS（85%对74%，P =.12）相当。在存在2个或更多高危特征时，肺叶切除对复发具有保护作用：具有2个高危特征的亚肺叶切除患者（风险比，1.77；95%置信区间，1.13 - 2.76，P =.012）或具有3 - 4个高危特征的患者（风险比，1.97；95%置信区间，1.25 - 3.10，P =.004）DFS较差。
对于存在多个高危特征的≤2 cm的ⅠA期NSCLC，应考虑行肺叶切除而非亚肺叶切除。
