亚肺叶切除术治疗80岁以上非小细胞肺癌患者：一项前瞻性、多中心研究

SCI

27 April 2023

Sublobar resection for non-small-cell lung cancer in octogenarians: a prospective,multicenter study

 (ATS, IF:5.1)

Mimae T, Saji H, Nakamura H, Okumura N, Tsuchida M, Sonobe M, MiyazakiT, Aokage K, Nakao M, Haruki T, Okada M, Suzuki K, Yoshino I, Sublobar resection for non-small-celllung cancer in octogenarians: a prospective, multicenter study, The Annals of Thoracic Surgery (2023),doi: https://doi.org/10.1016/j.athoracsur.2023.02.061.

BACKGROUND 背景  

Segmentectomy is a good surgical option for peripheral, early, non-small cell lung cancer (NSCLC) ≤2 cm. However, the role of sublobar resection including wedge resection and segmentectomy remains unclear for octogenarians with >2-cm but ≤4-cm early-stage NSCLC, for which lobectomy is a standard treatment.

对于≤2 cm的外周性、早期非小细胞肺癌(NSCLC)，肺段切除术是一个很好的手术选择。然而，亚肺叶切除术包括楔形切除术和肺段切除术在80多岁的>2cm但≤4cm的早期NSCLC中的作用尚不清楚，对于这些患者，肺叶切除术是一种标准治疗方法。

METHODS 方法  

By use of a prospective registry, 892 patients aged ≥80 years with operable lung cancer were enrolled at 82 institutions. Of these, we analyzed the clinicopathologic findings and surgical outcomes of 419 patients with NSCLC tumors of 2 to 4 cm during a median follow-up of 50.9 months between April 2015 and December 2016.

采用前瞻性研究，纳入82家机构的892例年龄≥80岁的可手术肺癌患者。其中，我们分析了419例2-4cm NSCLC肿瘤患者的临床病理表现和手术结果，中位随访时间为50.9个月，2015年4月至2016年12月。

RESULTS 结果  

Five-year overall survival (OS) was slightly but not significantly worse after sublobar resection than after lobectomy in the entire cohort (54.7% [95% CI, 43.2%-93.0%] vs 66.8% [95% CI, 60.8%-72.1%]; P = .09). Multivariable Cox regression analysis of OS revealed that these surgical procedures were not independent prognostic predictors (hazard ratio, 0.8 [0.5-1.1]; P = .16). The 5-year OS was comparable between 192 patients who could tolerate lobectomy but were treated by sublobar resection or lobectomy (67.5% [95% CI, 48.8%-80.6%] vs 71.5% [95% CI, 62.9%-78.4%]; P = .79). Recurrence after sublobar resection and lobectomy was locoregional in 11 (11%) of 97 and in 23 (7%) of 322 patients, respectively.

在整个队列中，亚肺叶切除术后的5年总生存率(OS)略低于肺叶切除术后的5年总生存率(54.7% [95% CI, 43.2%-93.0%] vs 66.8% [95% CI, 60.8%-72.1%];P = .09)。OS的多变量COX回归分析显示，这些手术方式不是独立的预后预测因素(风险比为0.8 [0.5-1.1];P = .16)。192例能够耐受肺叶切除术但接受亚肺叶切除术或肺叶切除术的患者的5年OS具有可比性(67.5% [95% CI, 48.8%-80.6%] vs 71.5% [95% CI, 62.9%-78.4%];P = .79)。亚肺叶切除术97例患者中有11例(11%)、肺叶切除术322例患者中有23例(7%)术后复发。

CONCLUSION 结论  

OS might be equivalent between sublobar resection with a secure surgical margin and lobectomy for selected patients aged ≥80 years with peripheral early-stage NSCLC tumors of 2 to 4 cm who can tolerate lobectomy.

对于年龄≥80岁、周围性早期NSCLC肿瘤2-4cm且能耐受肺叶切除术的患者，切缘阴性的亚肺叶切除术与肺叶切除术的OS可能相当。

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