CALGB140503研究:亚肺叶切除是早期周围型肺癌的标准术式?

CALGB140503 study:Is sublobectomy the standard procedure for early peripheral lung cancer?

肺叶切除术是早期非小细胞肺癌(non-small cell lung cancer,NSCLC)的标准手术方法,而近年来亚肺叶切除术(肺段切除术/肺楔形切除术)因其保留了更多肺实质,并有术后肺功能好、创伤相对小、恢复快等优点,在早期外周型NSCLC中逐渐推广,但此前尚缺乏规范的随机临床试验证实肺段切除术是否带来生存获益。美国的一项备受关注的CALGB140503研究结果自2022年世界肺癌大会(IASLC WCLC 2022)公布以来,引起业内激烈讨论。该研究于2023年2月9日在The New England Journal of Medicine杂志正式发表,研究旨在探讨亚肺叶切除术在早期周围型NSCLC(肿瘤直径≤2 cm)患者生存率上是否不劣于肺叶切除术。结果表明,对于肿瘤直径≤2 cm且经病理证实为肺门和纵隔淋巴结阴性的T1aN0M0期周围型NSCLC患者,亚肺叶切除术的生存率不亚于肺叶切除术。无论是解剖肺段切除还是楔形切除,亚肺叶切除都是一种有效的NSCLC治疗方法。该研究结果为亚肺叶切除术在肺功能保护等结果改善方面提供了有力证据,有望推进亚肺叶切除术的进一步应用。但鉴于该研究仍存在一定的局限性,亚肺叶切除术尤其是楔形切除术能否成为标准术式仍需探讨。本文对该研究进行解读,探讨其对临床实践的指导作用并总结其局限性。

While lobectomy is the standard surgical procedure for early-stage non-small cell lung cancer(NSCLC),sublobectomy(segmentectomy/wedge resection)has been gaining progress in early-stage peripheral NSCLC in recent years because it preserves more lung parenchyma and has the advantages of good postoperative lung function,relatively less trauma,and faster recovery.However,there has been a lack of standardized randomized clinical trials to study the survival benefits of sublobectomy.The results of a high-profile study from the USA,CALGB140503,have been the subject of intense industry debate since its presentation at the 2022 World Conference on Lung Cancer(IASLC WCLC2022).The study,which was published in The New England Journal of Medicine on February 9,2023,was designed to investigate whether sublobectomy was not inferior to lobectomy in terms of survival in patients with early-stage peripheral NSCLC(tumor diameter≤2 cm).The results showed that sublobectomy was not worse than lobectomy for survival in patients with T1aN0M0 peripheral NSCLC with tumor diameter≤2 cm and pathologically confirmed negative hilar and mediastinal lymph nodes.Sublobectomy,including anatomical segmentectomy and wedge resection is an effective NSCLC treatment.The results of this study provide strong evidence for the improved outcomes of sublobectomy in terms of lung function protection and are expected to promote the further use of sublobectomy.However,given the limitations of this study,whether sublobectomy,especially wedge resection,can become a standard procedure still needs to be explored.This paper presents an interpretation of this study and we invite experts in the field to discuss its usefulness in guiding clinical practice and summarise its limitations.