Lobectomy does not confer survival advantage over segmentectomy for non-small cell lung cancer with unsuspected nodal disease
Lobectomy does not confer survival advantage over segmentectomy for non-small cell lung cancer with unsuspected nodal disease
对于非小细胞肺癌合并未发现的淋巴结转移，肺叶切除术并不能比肺段切除术更具生存优势
OBJECTIVE:
Conversion to lobectomy is typically performed when positive lymph nodes are found during intentional segmentectomy. Our objective was to evaluate survival after lobectomy and segmentectomy in patients with unsuspected nodal metastases.
METHODS:
The National Cancer Database was queried for patients with clinical T1N0, pathological N1/N2 non-small cell lung cancer (NSCLC) who underwent either lobectomy or segmentectomy. Survival differences between the 2 groups were evaluated using a propensity score model. Cox regression analysis was used to evaluate predictors of overall survival, including adjuvant treatment. Statistical analysis was done using SPSS version 21.0 (IBM Corp, Armonk, NY).
RESULTS:
Between 2004 and 2015, unsuspected pathological N1 disease for clinical T1N0M0 NSCLC was found in 2.5% (228/9118) and 6.7% (8915/132,604) of patients who underwent segmentectomy and lobectomy, respectively. The incidence of unsuspected pathological N2 disease for clinical T1N0M0 NSCLC was 2.4% (224/9118) after segmentectomy and 3.9% (5192/132,604) after lobectomy. Using propensity matched pairs (227 pairs for N1 and 215 for N2), segmentectomy showed equivalent 5-year survival compared with lobectomy for the N1 group (41.9% vs 44.3%; P = .35), and N2 group (41.6% vs 37.2%; P = .99). In a multivariable model, adjuvant chemotherapy was associated with better survival of patients with unsuspected N1 (hazard ratio, 0.613; 95% confidence interval, 0.536-0.700; P < .001) and N2 (hazard ratio, 0.684; 95% confidence interval, 0.583-0.802; P < .001) nodal metastases.
CONCLUSIONS:
Survival is similar between lobectomy and segmentectomy for clinical T1N0 and unsuspected pathological N1/N2 nodal metastases. The use of adjuvant chemotherapy significantly improves survival in patients with lymph node metastasis (N1/N2) independent of the type of anatomic lung resection.
Journal J Thorac Cardiovasc Surg
IF 5.261
摘要要点
目标：当在节段切除术中发现阳性淋巴结时，通常会转而进行肺叶切除术。作者的目的是评估未发现的淋巴结转移患者行肺叶切除和肺段切除术后的生存率。
方法：作者在国家癌症数据库中查询了临床T1N0，病理N1/N2的接受肺叶切除术或肺段切除术非小细胞肺癌（NSCLC）患者。采用倾向评分模型评估两组间的生存差异。使用Cox回归分析评估总生存率（包括接受辅助治疗的患者在内）的预测因素。统计分析使用SPSS version 21.0（IBM Corp，Armonk，NY）软件进行。
结果：2004至2015年间，在接受肺段切除术和肺叶切除术的患者中，分别有2.5%（228/9118）和6.7%（8915/132604）的临床分期为T1N0M0的NSCLC患者出现了未预料到的病理N1淋巴结转移；2.4%（224/9118）和3.9%（5192/132604）的患者出现了未预料到的病理N2淋巴结转移。使用倾向匹配配对（N1组227对，N2组215对）分析，在N1组（41.9%对44.3%；P=0.35）和N2组（41.6%对37.2%；P=0.99）中，肺段切除术和肺叶切除术显示出同等的5年生存率。在多变量分析中，辅助化疗与未预料到的N1（危险比[HR]，0.613；95%置信区间[CI]，0.536-0.700；P<0.001）和N2（HR，0.684；95%CI，0.583-0.802；P<0.001）淋巴结转移患者的较好生存率相关。
结论：临床上T1N0出现未预料到的病理N1/N2淋巴结转移患者使用肺叶切除术或肺段切除术的生存率相似。在淋巴结转移（N1/N2）患者中，辅助化疗的使用显著提高了生存率，与术式无关。
Razi SS, Nguyen D, Villamizar N. Lobectomy does not confer survival advantage over segmentectomy for non-small cell lung cancer with unsuspected nodal disease. J Thorac Cardiovasc Surg. 2020 Jun;159(6):2469-2483.e4. doi: 10.1016/j.jtcvs.2019.10.165. Epub 2019 Nov 21. PMID: 31928821.
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