周围型实性小结节肺癌(直径≤2cm)术后复发转移危险因素分析及手术方式对生存影响的倾向性评分匹配研究

The risk factors for recurrence of peripheral solid small-nodule lung cancer(diameter≤2 cm) and the impact of different surgery types on survival: A propensity-score matching study

目的研究周围型实性小结节肺癌[直径(T)≤2 cm]术后复发转移危险因素和不同手术方式对预后的影响。方法从本中心前瞻性建设的中国西部肺癌数据库(Western China Lung Cancer Database,WCLCD)及美国监测、流行病学和最终结果(Surveillance,Epidemiology,and End Results,SEER)数据库中搜集2005~2016年行手术治疗的Ⅰ期周围型实性小结节肺癌(T≤2 cm)病例数据。通过单因素和多因素logistic回归分析术后复发转移危险因素。采用倾向性评分匹配比较肺段切除和肺叶切除的切除效果,并比较WCLCD和SEER数据库病例的生存差异。共纳入4 800例(WCLCD∶SEER=354∶4 446)周围型实性小结节肺癌(T≤2 cm N0M0)。对于T≤1 cm的实性小结节肺癌,按1∶4倾向性评分匹配到肺段组103例、肺叶组350例;对于1 cm1~2 cm的实性小结节肺癌,肺段切除术和肺叶切除术5年总生存率相当。相比SEER数据库,WCLCD数据库周围型实性小结节肺癌病例远期生存更好。

Objective To identify the risk factors for postoperative recurrence of peripheral solid small-nodule lung cancer(PSSNLC)(T≤2 cm),and to explore the effects of surgery types on prognosis.Methods We extracted data from Western China Lung Cancer Database(WCLCD),a prospectively maintained database at the Department of Thoracic Surgery,West China Hospital,Sichuan University,and Surveillance,Epidemiology,and End Results(SEER)database for peripheral solid small-nodule lung cancer patients(T≤2 cm N0M0,stageⅠ)who underwent surgery between 2005 and 2016.We used univariable and multivariable logistic regression to analyze risk factors for recurrence of PSSNLC.We applied propensity-score matching to compare the long-term results of segmentectomy and lobectomy,as well as the survival of patients from WCLCD and SEER.We finally included 4800 patients with PSSNLC(T≤2 cm N0M0)(WCLCD:SEER=354∶4446).We matched 103 segmentectomies and 350 lobectomies in T≤1 cm,and 280 segmentectomies and 1067 lobectomies in 1 cm<T≤2 cm at a ratio of 1:4 according to the propensity scores.Results The results of multivariable logistic regression showed that older age(HR=1.04,95%CI 1.03-1.05,P<0.001),male(HR=1.60,95%CI 1.37-1.88,P<0.001),squamous carcinoma(HR=1.65,95%CI 1.40-1.95,P<0.001),lymph node removed(HR=0.97,95%CI 0.96-0.99,P<0.001)were risk factors for recurrence after surgery.We found that segmentectomy and lobectomy could reach similar survival in PSSNLC patient with either T≤1 cm or 1 cm<T≤2 cm.Analyses of 1441 patients with PSSNLC after matching(WCLCD:SEER=325:1116)indicated that the 5-year overall survival rate of the patients in WCLCD was better than that in SEER database(89.8%vs.77.1%,P<0.001).Conclusion Older age,male,squamous carcinoma,and lymph node removed are the risk factors for recurrence of PSSNLC.Segmentectomy shows similar survival in PSSNLC patient with either T≤1 cm or 1 cm<T≤2 cm N0M0.The patients in the WCLCD shows better survival compared with of the patients in the SEER database.