亚肺叶切除与肺叶切除在T≤3 cm N0M0合并胸膜侵犯的早期非小细胞肺癌患者中的远期生存比较  

Long-term Survival Comparison of Sublobar Resection Versus Lobectomy in Early-stage Non-small Cell Lung Cancer Patients(T≤3 cm N0M0)with Visceral Pleural Invasion

作　　者：付浩[1] 杨永波[1] 梁震[1] 熊宏超[1] FU Hao;YANG Yong-bo;LIANG Zhen;XIONG Hong-chao(Department of Thoracic Surgery,Peking University Cancer Hospital,Beijing100142,China)

机构地区：[1]北京大学肿瘤医院胸部肿瘤外一科,北京100142

出　　处：《科学技术与工程》2025年第7期2732-2740,共9页Science Technology and Engineering

基　　金：国家重点研发计划(2021YFC2500900)。

摘　　要：目前研究表明对于分期为T1N0M0的早期非小细胞肺癌,亚肺叶切除的远期疗效不亚于肺叶切除术。但这部分早期肺癌患者仍有可能发生胸膜侵犯,胸膜侵犯与不良预后相关。为此,需对比分析亚肺叶切除和肺叶切除对T≤3 cm N0M0合并胸膜侵犯的非小细胞肺癌患者的远期疗效。现基于SEER(Surveillance,Epidemiology,and End Results)数据库,将2010—2020年肿瘤分期为T≤3 cm N0M0伴有胸膜侵犯的非小细胞肺癌患者分为亚肺叶切除组和肺叶切除组,比较两组患者的肿瘤特异性生存(cancer specific survival,CSS)和总生存(overall survival,OS)。倾向性评分匹配后的单因素分析显示,亚肺叶切除与肺叶切除的CSS和OS均无显著差异。多因素分析亦显示,手术方式并非T≤3 cm N0M0合并胸膜侵犯的非小细胞肺癌患者CSS(HR=1.185,95%CI:0.745~1.885,P=0.472)和OS(HR=1.171,95%CI:0.869~1.577,P=0.299)的独立的预后因素。亚组分析显示,在各亚组中,两组的CSS和OS均无显著差异。竞争风险模型多因素亦显示,亚肺叶切除与肺叶切除的肺癌特异性死亡率无显著差异。对于分期为T≤3 cm N0M0合并胸膜侵犯的非小细胞肺癌患者,亚肺叶切除的远期生存与肺叶切除相当,可作为该患者群体的手术方式选择。Recent studies indicate that for early-stage non-small cell lung cancer(NSCLC)classified as T1N0M0,sublobar resection offers long-term outcomes comparable to lobectomy.However,these early-stage patients may still experience pleural invasion,which is associated with poor prognosis.It is necessary to compare the long-term efficacy of sublobar resection versus lobectomy in patients with T≤3 cm N0M0 NSCLC accompanied by pleural invasion.Research data were sourced from the SEER(Surveillance,Epidemiology,and End Results)database.Patients diagnosed were from between 2010 and 2020 with T≤3 cm N0M0 NSCLC and pleural invasion.Patients were divided into sublobar resection and lobectomy groups,and their cancer-specific survival(CSS)and overall survival(OS)were compared.Univariate analysis post-matching reveale no significant differences in CSS and OS between the sublobar resection and lobectomy groups.Multivariate analysis also indicate that the surgical approach is not an independent prognostic factor for CSS(HR=1.185,95%CI:0.745~1.885,P=0.472)and OS(HR=1.171,95%CI:0.869~1.577,P=0.299)in patients with T≤3 cm N0M0 NSCLC and pleural invasion.Subgroup analyses show no significant differences in CSS and OS between the two groups across various subgroups.Competing risk model multivariate analysis also demonstrate no significant difference in lung cancer-specific mortality between sublobar resection and lobectomy.In conclusion,for patients with T≤3 cm N0M0 NSCLC accompanied by pleural invasion,sublobar resection offers long-term survival outcomes comparable to lobectomy and can be considered a viable surgical option for this patient population.

关 键 词：非小细胞肺癌 亚肺叶切除 肺叶切除 远期生存 

分 类 号：R734.2[医药卫生—肿瘤]