肺段切除在早期浸润性肺腺癌中的应用评价

Evaluation of segmentectomy in patients with early primary lung invasive adenocarcinoma

目的探讨亚肺叶切除和肺叶切除在原发浸润性肺腺癌中的预后效果。方法通过HIS系统(Hospital Information System)选择肿瘤大小在0~2cm的原发浸润性肺腺癌患者作为研究对象。通过倾向性匹配分析来消除潜在的偏倚,使用Kaplan-Meier生存分析比较亚肺叶切除组和肺叶切除组的总体生存时间。结果共纳入了154例肿瘤大小为0~2cm的浸润性肺腺癌患者,其中肺段切除31例,肺叶切除123例,3年生存时间的分析的结果显示:肺段切除的预后和肺叶切除相似(OS:HR,1.29(0.13-12.81),P=0.81);154例浸润性腺癌患者术后10例出现并发症,其中肺段切除组1例(3.2%)出现持续漏气(超过7d);肺叶切除组出现9例,2例出现持续漏气,1例出现肺部感染,2例出现皮下气肿,1例出现胸腔积液。基于年龄、性别、吸烟史、慢性病史、肿瘤大小及淋巴结清扫数目等变量进行倾向性匹配分析获得28对肺段切除和肺叶切除病例,两组的近期总体生存时间无明显统计学差异性(OS:HR,2.50(0.12-52.20),P=0.38)。结论肺段切除可作为早期原发浸润性肺腺癌的可选治疗方法。

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.