肺类癌的切除与否的预后对比

SCI

29 April 2023

Prognosis of Unresected versus Resected Small Pulmonary Carcinoid Tumors

（The Annals of thoracic surgery；IF：5.102）

Roat-Shumway S, Tonelli CM, Baker MS, Abdelsattar ZM. Prognosis of Unresected versus Resected Small Pulmonary Carcinoid Tumors. Ann Thorac Surg. 2023 Apr 11:S0003-4975(23)00372-7. doi: 10.1016/j.athoracsur.2023.04.008. Epub ahead of print. PMID: 37054928.

Correspondence/Reprint requests: 

Zaid M. Abdelsattar, MD, MS 

Loyola University Medical Center 

2160 S 1st Ave 

Maywood, IL 60153 

zaid.abdelsattar@lumc.edu

BACKGROUND 背景  

Previous studies have shown that overall survival after lung resection for pulmonary carcinoid tumors is favorable. It is unclear what the prognosis is for observation rather than resection for small carcinoid tumors. 

先前的研究表明，肺类癌的肺切除对于总生存期是有利的。目前尚不清楚观察而非切除的小的类癌的预后如何。

METHODS 方法  

We queried the National Cancer Database to identify patients presenting with primary pulmonary carcinoid tumors between 2004 and 2017. We included patients with small (<3cm), primary pulmonary carcinoids, who were observed or underwent a lung resection. To minimize confounding by indication, we used propensity score matching, while accounting for age, sex, race, insurance type, Charlson-Deyo comorbidity score, typical and atypical histology, tumor size, and year of diagnosis. We used Kaplan Meier survival analyses to compare 5-year overall survival in the matched cohorts.

我们查询了国家癌症数据库，以找出2004年至2017年间出现原发性肺类癌的患者。我们纳入了观察或接受肺切除术的小的（<3cm）原发性肺类癌患者。为了减少适应症的混淆，我们使用倾向评分匹配，同时考虑年龄、性别、种族、保险种类、Charlson-Deyo合并症评分、典型及非典型组织学、肿瘤大小和诊断年份。我们使用Kaplan Meier生存分析来比较匹配队列的5年总生存期。

RESULTS 结果  

Of 8,435 patients with small pulmonary carcinoids, 783 (9.3%) underwent observation and 7,652 (91%) underwent surgical resection. After propensity score matching, surgical resection was associated with improved 5-year overall survival (66% vs 81%, p<0.001). No significant difference in overall survival was found between wedge and anatomic resection (88% vs. 88%, p=0.83). In patients undergoing resection, lymph node sampling at time of wedge and anatomic resection increased 5-year overall survival (90% vs. 86%, p = 0.0042; 88% vs. 82%, p = 0.04, respectively). 

在8435例小的肺类癌患者中，783例（9.3%）接受了观察和7652（91%）接受了手术切除。倾向评分匹配后，手术切除与改善的 5 年总生存期相关（66% vs 81%，p<0.001）。楔形切除术和解剖切除术的总生存期无显著差异（88% vs 88%，p=0.83）。在接受切除术的患者中，楔形和解剖切除时的淋巴结取样增加了 5 年总生存期（分别为 90% vs 86%，p = 0.0042; 88% vs 82%，p = 0.04）。

CONCLUSION 结论  

Surgical resection of small pulmonary carcinoids is associated with improved survival compared to observation. When surgery is performed, wedge and anatomic resection result in similar survival and lymph node sampling improves survival. 

与观察相比，手术切除小的肺类癌可提高生存率。当施行手术时，楔形和解剖切除可导致相似的生存率，淋巴结取样可提高生存率。

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