Yuhara Shinji, Nagano Masaaki, Cong Yue, Nakao Keita, Kawashima Mitsuaki, Toyokawa Gouji, Konoeda Chihiro, Luo Yan, Sato Masaaki
Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, 7-3-1, Hongo Bunkyo-ku, Tokyo, Japan.
Center for Medical Education and Internationalization, Kyoto University Graduate School of Medicine, Yoshida-Honmachi, Sakyo-ku, Kyoto-shi, Kyoto, Japan.
Gen Thorac Cardiovasc Surg. 2025 Sep 18. doi: 10.1007/s11748-025-02202-6.
Studies suggest that non-small cell lung cancer of the superior segment (S6) affects different lymphatic pathways and results in worse prognosis than basal segment tumors. We aimed to compare survival after lobectomy between non-small cell lung cancer in the S6 and basal segments, focusing specifically on pure-solid tumors, which have higher lymph node metastasis rates and worse prognosis.
We retrospectively reviewed patients with pure-solid, clinical N0 M0, ≤ 5-cm, lower-lobe non-small cell lung cancer who underwent lobectomy with hilar and mediastinal lymphadenectomy between April 2009 and December 2021. Overall survival, recurrence-free survival and clinicopathological characteristics were evaluated.
We categorized 157 patients into S6 (n = 58) and basal segment (n = 99) groups. The 5-year overall survival (66.4% vs. 68.6%, respectively; p = 0.519; hazard ratio, 1.19; 95% confidence interval, 0.70-2.03), and recurrence-free survival (54.8% vs. 65.5%, respectively; p = 0.452; hazard ratio, 1.22; 95% confidence interval, 0.72-2.06) rates were comparable between the S6 and basal segment groups. Multivariable Cox regression analyses indicated that tumor location was not associated with overall or recurrence-free survival. The S6 group showed a higher tendency for visceral pleural invasion compared with the basal segment group. Superior mediastinal lymph node metastasis was pathologically confirmed exclusively in the S6 group (two cases).
No significant difference in survival was observed between S6 and basal segment pure-solid non-small cell lung cancer after lobectomy with hilar and mediastinal lymph node dissection.
研究表明，上叶前段（S6）非小细胞肺癌影响不同的淋巴途径，且预后比基底段肿瘤更差。我们旨在比较S6段和基底段非小细胞肺癌肺叶切除术后的生存率，特别关注纯实性肿瘤，这类肿瘤具有更高的淋巴结转移率和更差的预后。
我们回顾性分析了2009年4月至2021年12月期间接受肺叶切除加肺门和纵隔淋巴结清扫术的纯实性、临床N0 M0、直径≤5 cm的下叶非小细胞肺癌患者。评估总生存期、无复发生存期和临床病理特征。
我们将157例患者分为S6组（n = 58）和基底段组（n = 99）。5年总生存率（分别为66.4%和68.6%；p = 0.519；风险比，1.19；95%置信区间，0.70 - 2.03）和无复发生存率（分别为54.8%和65.5%；p = 0.452；风险比，1.22；95%置信区间，0.72 - 2.06）在S6组和基底段组之间具有可比性。多变量Cox回归分析表明，肿瘤位置与总生存期或无复发生存期无关。与基底段组相比，S6组脏层胸膜侵犯的倾向更高。仅在S6组病理证实有上纵隔淋巴结转移（2例）。
在进行肺门和纵隔淋巴结清扫的肺叶切除术后，S6段和基底段纯实性非小细胞肺癌的生存率无显著差异。
