精确选择小叶切除术治疗小型非小细胞肺癌

Accurate Selection of Sublobar Resection for Small Non-small Cell Lung Cancer

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ANNALS OF SURGICAL ONCOLOGY

影响因子:3.5

分区:医学2区 / 外科2区肿瘤学3区

发表日期:2025 Feb

作者: Nozomu Motono, Takaki Mizoguchi, Masahito Ishikawa, Shun Iwai, Yoshihito Iijima, Hidetaka Uramoto

DOI: 10.1245/s10434-024-16027-9

摘要

尽管小叶切除术（楔形切除 [Wed] 或 Segmentectomy [Seg]）已成为日本临床期IA1和IA2非小细胞肺癌 (NSCLC) 的标准手术程序，但该手术在实际临床中的预后影响及术后并发症尚不清楚。本研究回顾性分析了2012年至2021年期间接受手术的470例临床期≤ IA2 NSCLC患者的预后不良和术后并发症的风险因素。在具有高于0.5的 consolidation-to-tumor ratio (CTR) 的患者中，5年无复发生存率 (RFS) 在Wed组（72.1%）明显低于Seg组（85.8%）和Lob组（86.8%）（p < 0.01），但Seg组与Lob组之间差异无统计学意义。在CTR为0.5或以下的患者中，三组的5年RFS无显著差异。多变量分析显示，Wed组的预后明显差于Lob组（风险比，2.83；p < 0.01），但Wed与Seg组或Seg与Lob组之间差异无统计学意义。术后并发症的多变量分析显示，Wed组的风险明显低于Seg组（比值比，0.31；p < 0.01）。Seg可能成为临床期IA1和IA2 NSCLC患者的标准手术方案。Wed适用于CTR为0.5或以下的患者，且具有避免术后并发症的优势。

Abstract

Although sublobar resection (wedge resection [Wed] or segmentectomy [Seg]) has become a standard operative procedure for clinical stages IA1 and IA2 non-small cell lung cancer (NSCLC) in Japan, the impact of this procedure on the prognosis and postoperative complications in real-world clinical practice is unknown.This study retrospectively analyzed risk factors for a poor prognosis and postoperative complications of 470 patients with clinical stage ≤ IA2 NSCLC who underwent surgery from 2012 to 2021.Among the patients with a consolidation-to-tumor ratio (CTR) higher than 0.5, the 5-year relapse-free survival (RFS) rate was significantly lower in the Wed group (72.1%) than in the Seg (85.8%) and Lob (86.8%) groups (p < 0.01), but the difference between the Seg and Lob groups was not significant. Among patients with a CTR of 0.5 or lower, the 5-year RFS rate did not differ significantly among the three groups. Multivariable analysis of RFS showed that the prognosis was significantly worse in the Wed group than in the Lob group (hazard ratio, 2.83; p < 0.01), but the difference between the Wed and Seg groups or the between Seg and Lob groups was not significant. Multivariable analysis of postoperative complications showed a significantly lower risk in the Wed group than in the Seg group (odds ratio, 0.31; p < 0.01).Seg could become the standard operative procedure for clinical stages IA1 and IA2 NSCLC patients. Wed is suggested to be an option for patients with a CTR of 0.5 or lower and has the advantage of avoiding postoperative complications.