Evaluation of segmentectomy in patients with early primary lung invasive adenocarcinoma

doi:10.3877/cma.j.issn.1674-6902.2019.04.014

Abstract

Abstract:

Objective

To compare the prognostic effect of segmentectomy and lobectomy for the patients with early primary lung invasive adenocarcinoma (PLIA).

Methods

Hospital Information System (HIS) was used to identify the patients who underwent sublobar resection or lobectomy for PLIA with 0-2 cm in size. Propensity score-matching (PSM) was used to adjust the potential confounding. The Kaplan-Meier method was used to assess the overall survival (OS) and lung cancer-specific survival (LCSS).

Results

In this study, 154 patients were obtained from HIS, of whom 31 patients underwent segmentectomy and 123 underwent lobectomy. The prognosis of underwent segmentectomy was equivalent to underwent lobectomy in terms of 3-year OS (OS: HR, 1.29 (0.13-12.81), P=0.81). 10 cases of postoperative complications in these patients, 1 case (3.2%) had continuous air leakage (over 7 d) in underwent segmentectomy. 9 cases(7.3%) in underwent lobectomy, 2 cases of continuous air leakage, 1 case of pulmonary infection, 2 cases of subcutaneous emphysema, 1 case of pleural effusion. Based on age, sex, smoking history, chronic history, tumor size and number of lymph node dissection, analysis of tendentious matching to obtain 28 cases of lung segment resection and lobectomy. And segmentectomy is similar to lobectomy after the PSM (OS: HR, 2.50 (0.12-52.20), P=0.38).

Conclusion

Segmentectomy can be considered as an alternative choice for the patients with PLIA.

Key words: Adenocarcinoma of lung, Invasive adenocarcinoma, Segmentectomy, Pneumonectomy

Qiang Wu, Xiaolin Wang, Shoujian Li, Qingwen Liu, Guiwang Tang, Shichun Lu, Yusheng Shu. Evaluation of segmentectomy in patients with early primary lung invasive adenocarcinoma[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2019, 12(04): 473-477.

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https://zhfbjbzz.cma-cmc.com.cn/EN/Y2019/V12/I04/473

Figures/Tables 3

References 22

1	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6): 394-424.
2	陈万青，李　贺，孙可欣，等. 2014年中国恶性肿瘤发病和死亡分析[J]. 中华肿瘤杂志，2018, 40(1): 5-13.
3	钱桂生. 肺癌不同病程类型发病率的发病情况及其原因[J/CD]. 中华肺部疾病杂志(电子版), 2011, 4(1): 1-6.
4	李　羲，钱桂生. 肺癌临床的罕见表现[J/CD]. 中华肺部疾病杂志(电子版), 2013, 6(1): 4-7.
5	Russell PA, Wainer Z, Wright GM, et al. Does lung adenocarcinoma subtype predict patient survival？：A clinicopathologic study based on the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary lung adenocarcinoma classification[J]. J Thorac Oncol, 2011, 6(9): 1496-1504.
6	Kadota K, Villena-Vargas J, Yoshizawa A, et al. Prognostic significance of adenocarcinoma in situ, minimally invasive adenocarcinoma, and nonmucinous lepidic predominant invasive adenocarcinoma of the lung in patients with stage I disease[J]. Am J Surg Pathol, 2014, 38(4): 448-460.
7	NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines？) Non-Small Cell Lung Cancer (Version 2.2018). 2018 Available from: URL
8	Okada M, Mimae T, Tsutani Y, et al. Segmentectomy versus lobectomy for clinical stage IA lung adenocarcinoma[J]. Ann Cardiothorac Surg, 2014, 3(2): 153-159.
9	Khullar OV, Liu Y, Gillespie T, et al. Survival After Sublobar Resection versus Lobectomy for Clinical Stage IA Lung Cancer: An Analysis from the National Cancer Data Base[J]. J Thorac Oncol, 2015, 10(11): 1625-1633.
10	Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer[J]. Ann Thorac Surg, 1995, 60(3): 615-623.
11	孙　涛，顾江魁，胡一淼. 胸腔镜肺段切除术和肺叶切除术对早期非小细胞肺癌患者中远期预后影响分析[J/CD]. 中国医学前沿杂志(电子版), 2017, 9(8): 86-89.
12	吴云华，杜仕建，戴学兵，等. 用全胸腔镜下肺叶切除术与开胸肺叶切除术治疗早期肺癌的效果对比[J]. 当代医药论丛，2017, 15(22): 114-115.
13	Chamogeorgakis T, Ieromonachos C, Georgiannakis E, et al. Does lobectomy achieve better survival and recurrence rates than limited pulmonary resection for T1N0M0 non-small cell lung cancer patients？[J]. Interact Cardiov Th, 2009, 8(3): 364-372.
14	Altorki NK, Yip R, Hanaoka T, et al. Sublobar resection is equivalent to lobectomy for clinical stage 1A lung cancer in solid nodules[J]. J Thorac Cardiov Sur, 2014, 147(2): 754-764.
15	Shimamoto A, Ito A, Kobayashi A, et al. P3. 04-016 Surgical Implications of the New Lung Adenocarcinoma Classification-Usefulness for Selecting Cases Undergoing Sublobar Resection: Topic: Miscellaneous I[J]. J Thorac Oncol, 2017, 12(1): S1393-S1394.
16	Cheng X, Onaitis MW, D′amico TA, et al. Minimally Invasive Thoracic Surgery 3.0: Lessons Learned From the History of Lung Cancer Surgery[J]. Ann Surg, 2018, 267(1): 37-38.
17	Schuchert MJ, Normolle DP, Awais O, et al. Factors influencing recurrence following anatomic lung resection for clinical stage I non-small cell lung cancer[J]. Lung Cancer, 2019, 128: 145-151.
18	Bedetti B, Bertolaccini L, Rocco R, et al. Segmentectomy versus lobectomy for stage I non-small cell lung cancer: a systematic review and meta-analysis[J]. J Thorac Dis, 2017, 9(6): 1615-1623.
19	Kamel MK, Rahouma M, Lee B, et al. Segmentectomy Is Equivalent to Lobectomy in Hypermetabolic Clinical Stage IA Lung Adenocarcinomas[J]. Ann Thorac Surg, 2019, 107(1): 217-223.
20	张艳娇，高禹舜. 肺癌胸腔镜肺叶切除、胸腔镜肺段切除与开胸肺叶切除术后对肺功能影响的研究[J]. 中国肺癌杂志，2016, 19(10): 700-704.
21	张　裘，黄国喜. 胸腔镜下肺段切除术与肺叶切除术对肺癌患者肺功能的影响[J]. 局解手术学杂志，2016, 25(12): 887-889.
22	毛　宇，郭　伟，黎　明，等. 计划性亚肺叶切除术对肺功能的影响[J/CD]. 中华胸部外科电子杂志，2017, 4(2): 101-106.

临床资料		肺段切除(n＝31)	肺叶切除(n＝123)	P值
临床资料		肺段切除(n＝31)	肺叶切除(n＝123)	PSM值	PSM^a
年龄[a(±s)]		55.2±11.0	57.7±9.4	0.21	0.95
男性(%)		16(51.6)	54(43.9)	0.28	1
吸烟史(%)		15(48.4)	54(43.9)	0.82	1
肿瘤大小≤1 cm(%)		13(41.9)	13(10.7)	<0.001	0.57
慢性病史(%)		1(3.2)	45(36.6)	0.4	1
术前CT表现
	亚实性结节	31	103	0.01	无
	实性结节	0	20
N1站淋巴结清扫				0.008	无
	(0～10)(%)	31(100)	102(82.9)
	>10(%)	0(0)	21(17.1)
N2站淋巴结清扫				<0.001	无
	(0～10)(%)	31(100)	79(64.2)
	>10(%)	0(0)	44(35.8)

临床资料		肺段切除(n＝31)	肺叶切除(n＝123)	P值
临床资料		肺段切除(n＝31)	肺叶切除(n＝123)	PSM值	PSM^a
年龄[a(±s)]		55.2±11.0	57.7±9.4	0.21	0.95
男性(%)		16(51.6)	54(43.9)	0.28	1
吸烟史(%)		15(48.4)	54(43.9)	0.82	1
肿瘤大小≤1 cm(%)		13(41.9)	13(10.7)	<0.001	0.57
慢性病史(%)		1(3.2)	45(36.6)	0.4	1
术前CT表现
	亚实性结节	31	103	0.01	无
	实性结节	0	20
N1站淋巴结清扫				0.008	无
	(0～10)(%)	31(100)	102(82.9)
	>10(%)	0(0)	21(17.1)
N2站淋巴结清扫				<0.001	无
	(0～10)(%)	31(100)	79(64.2)
	>10(%)	0(0)	44(35.8)

伴随疾病或既往病史	肺段切除(31)	肺叶切除(123)
高血压	0(0)	34(27.64)
糖尿病	0(0)	5(4.07)
冠心病	0(0)	2(1.63)
室性早搏	0(0)	1(0.81)
心房纤颤	0(0)	1(0.81)
脑缺血或脑梗死	0(0)	4(3.25)
慢性支气管炎	1(3.2)	0(0)
支气管哮喘	0(0)	1(0.81)
肝硬化	0(0)	1(0.81)
肺结核	1(3.2)	3(2.44)
良性肿瘤	0(0)	7(5.69)
鼻息肉	0(0)	2(1.63)

伴随疾病或既往病史	肺段切除(31)	肺叶切除(123)
高血压	0(0)	34(27.64)
糖尿病	0(0)	5(4.07)
冠心病	0(0)	2(1.63)
室性早搏	0(0)	1(0.81)
心房纤颤	0(0)	1(0.81)
脑缺血或脑梗死	0(0)	4(3.25)
慢性支气管炎	1(3.2)	0(0)
支气管哮喘	0(0)	1(0.81)
肝硬化	0(0)	1(0.81)
肺结核	1(3.2)	3(2.44)
良性肿瘤	0(0)	7(5.69)
鼻息肉	0(0)	2(1.63)

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