精确选择用于小型非小细胞肺癌的Sublobar切除
Accurate Selection of Sublobar Resection for Small Non-small Cell Lung Cancer
影响因子:3.50000
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
摘要
尽管Sublobar切除（楔形切除[Wed]或分割切除术[SEG]）已成为日本临床阶段IA1和IA2非小细胞肺癌（NSCLC）的标准手术方法470例临床期≤IA2NSCLC的患者从20121年到2021年接受手术。 SEG和LOB组并不重要。在CTR为0.5或更低的患者中，这三组的5年RFS率在5年中没有显着差异。 RF的多变量分析表明，在WED组中的预后明显差于LOB组（危险比，2.83； p <0.01），但是WED和SEG组或SEG组和LOB组之间的差异并不重要。术后并发症的多变量分析显示，WED组的风险明显低于SEG组（优势比，0.31； P <0.01）.SEG可能成为IA1和IA2 NSCLC患者临床阶段的标准手术程序。对于CTR为0.5或更低的患者，WED被认为是一种选择，其优势是避免术后并发症。
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.