支气管袖式肺叶切除术后管内型与浸润型非小细胞肺癌的预后分析  

Prognostic analysis between endobronchial and invasive bronchial non-small cell lung cancer in sleeve resection

作　　者：周彬 徐欣楠 徐小雄[1] 靳凯淇 姜格宁[1] 戴洁[1] Zhou Bin;Xu Xinnan;Xu Xiaoxiong;Jin Kaiqi;Jiang Gening;Dai Jie(Department of Thoracic Surgery,Shanghai Pulmonary Hospital,Tongji University School of Medicine,Shanghai 200433,China)

机构地区：[1]同济大学附属上海市肺科医院胸外科,上海200433

出　　处：《中华外科杂志》2025年第3期240-247,共8页Chinese Journal of Surgery

基　　金：国家自然科学基金(82172848)。

摘　　要：目的探讨支气管袖式肺叶切除术后管内局限型(管内型)与管壁浸润型(浸润型)非小细胞肺癌(NSCLC)患者的预后差异。方法本研究为回顾性队列研究。回顾性分析2014年1月至2016年12月在同济大学附属上海市肺科医院胸外科接受支气管袖式肺叶切除术的200例患者资料。其中男性181例,女性19例,年龄(61.3±8.1)岁(范围:30~81岁)。基于影像学资料将患者分为管内型组(n=71)和浸润型组(n=129),收集并分析两组患者的临床资料与预后情况。以性别、年龄、高血压病、糖尿病、吸烟史、病理学类型、肿瘤大小、分期、手术方式、手术部位及袖式方式为协变量,采用最邻近匹配法,将管内型组和浸润型组按1∶1进行倾向性评分匹配。采用Kaplan-Meier法绘制生存曲线,并使用Log-rank检验比较组间差异。采用独立样本t检验、Mann-Whitney U检验、χ^(2)检验或Fisher确切概率法进行组间比较。结果倾向性评分匹配后,浸润型组和管内型组各纳入71例患者,两组间基线资料无差异(P值均>0.05)。管内型组的总体生存与无病生存均优于浸润型组(Log-rank检验:P=0.014、0.027)。进一步亚组分析结果显示,微创入路手术亚组中,管内型组的无病生存优于浸润型组(Log-rank检验:P=0.002),而开胸手术亚组中两组的无病生存无差异(Log-rank检验:P=0.290)。右肺上叶袖式切除亚组中,管内型组的无病生存优于浸润型组(Log-rank检验:P=0.039)。对于Ⅱ~Ⅲ期亚组的患者,管内型组的无病生存优于浸润型组(Log-rank检验:P=0.005)。结论支气管袖式肺叶切除术后,管内型NSCLC患者的总体生存和无病生存均优于浸润型,特别是对于接受微创入路手术、右肺上叶袖式切除术及Ⅱ~Ⅲ期的患者。ObjectiveTo investigate the prognostic differences between endobronchial and invasive bronchial characteristics in patients with non-small cell lung cancer(NSCLC)undergoing sleeve lobectomy.MethodsThis is a retrospective cohort study.A retrospective analysis was conducted on clinical data of 200 NSCLC patients who underwent sleeve lobectomy at the Department of Thoracic Surgery,Shanghai Pulmonary Hospital between January 2014 and December 2016.There were 181 males and 19 females,aged(61.3±8.1)years(range:30 to 81 years).Based on imaging data,they were divided into the endobronchial group(n=71)and the invasive bronchial group(n=129).Clinical data and prognosis were collected and analyzed.Sex,age,hypertension,diabetes,smoking history,pathology type,tumor size,staging,surgical method,surgical site,and sleeve technique were included as covariates.Propensity score matching was performed with a 1∶1 ratio between the endobronchial and invasive bronchial groups using the nearest-neighbor matching method.The Kaplan-Meier method was used to plot survival curves,and the Log-rank test was applied to compare differences between groups.Independent sample t tests,Mann-Whitney U tests,χ^(2) tests,or Fisher′s exact tests was used for group comparisons.ResultsAfter propensity score matching,71 cases from each group(endobronchial and invasive bronchial)were included,with no significant differences in baseline characteristics between the two groups(all P>0.05).Endobronchial group showed significantly better overall survival(OS)and disease-free survival(DFS)compared to invasive bronchial group(Log-rank test:P=0.014,0.027).Further subgroup analysis revealed that in the minimally invasive surgery subgroup,the DFS of the endobronchial group was significantly better than that of the invasive bronchial group(Log-rank test:P=0.002),while in the open thoracotomy subgroup,there was no significant difference in DFS between the two groups(Log-rank test:P=0.290).In the right upper lobe sleeve resection subgroup,the endobronchial group had

关 键 词：癌 非小细胞肺 胸外科手术 支气管袖式肺叶切除 管内型 浸润型 预后 

分 类 号：R73[医药卫生—肿瘤]