3D指导锥式肺段切除术治疗肺实质深部早期肺癌的肿瘤学疗效研究

Oncological outcome of 3D-guided cone-shaped segmentectomy for deep early-stage lung cancer

目的探讨3D指导锥式肺段切除术治疗直径≤2 cm深部早期肺癌的肿瘤学疗效是否不亚于肺叶切除术。方法回顾性筛选2012—2018年在南京医科大学第一附属医院行肺叶切除术或肺段切除术肿瘤直径≤2 cm深部早期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者。肺段切除应用3D指导锥式肺段切除术,以肺段和亚段为切除单位。采用Cox比例风险回归模型对患者预后进行单因素和多因素回归分析。采用倾向性评分匹配分析对肺段组、肺叶组患者进行1∶1匹配,比较两组患者的远期生存预后。结果共纳入349例患者,其中肺段组222例,肺叶组127例。肺叶组患者年龄、结节总大小、实性成分大小、纯实性结节占比显著高于肺段组。中位随访时间49个月,所有患者手术切缘均为阴性,肺段组局部复发率为0.45%,肺段组患者的无病生存(disease-free survival,DFS)率和总生存(overall survival,OS)率显著高于肺叶组(5年DFS:98.64%vs.89.77%,P<0.001;5年OS率:99.55%vs.92.10%,P<0.001)。而多因素回归分析表明,在调整影响因素后肺段组与肺叶组患者预后差异无统计学意义[DFS率:HR=0.52,95%CI(0.11,2.59),P=0.427;OS率:HR=0.08,95%CI(0.00,3.24),P=0.179]。倾向性评分匹配后,肺段组和肺叶组各77例患者,平均结节大小分别为1.44 cm和1.49 cm,实性成分占比(CTR)平均值分别为0.46和0.52,两组DFS率(P=0.640)和OS率(P=0.310)差异无统计学意义。结论3D指导锥式肺段切除术可有效治疗直径≤2 cm的肺实质深部早期低度恶性NSCLC,其肿瘤学疗效不亚于肺叶切除术。

Objective To investigate whether 3D-guided cone-shaped segmentectomy can achieve comparable long-term outcomes with lobectomy for deep early-stage lung cancer with diameter≤2 cm.Methods We retrospectively screened patients with deep early-stage non-small cell lung cancer(NSCLC)with diameter≤2 cm who underwent lobectomy or segmentectomy in the First Affiliated Hospital of Nanjing Medical University from 2012 to 2018.All pulmonary segmentectomy was performed using 3D-guided cone-shaped segmentectomy with segment or subsegment as the resection unit.Univariate and multivariate regression analyses were performed by Cox proportional hazard regression model.The patients who underwent segmentectomy and lobectomy were matched 1∶1 by propensity-score matching analysis.The oncological outcomes of two groups were compared.Results Our cohort was divided into a segmentectomy group(n=222)and a lobectomy group(n=127).The age,total nodule size,solid component size and proportion of pure solid nodule in the lobectomy group were significantly higher than those in the segmentectomy group.The median follow-up time was 49 months.Surgical margins were negative in all patients.The local recurrence rate of segmentectomy was 0.45%.The disease-free survival(DFS)rate and overall survival(OS)rate of patients in the segmentectomy group were significantly better than those in the lobectomy group(5-year DFS rate:98.64%vs.89.77%,P<0.001;5-year OS rate:99.55%vs.92.10%,P<0.001).Multivariate regression analysis showed that the differences between two groups were not significant[DFS rate:HR=0.52.95%CI(0.11,2.59),P=0.427;OS rate:HR=0.08.95%CI(0.00,3.24),P=0.179]after adjusting for other factors.After propensity score matching,77 patients were preserved in both segmentectomy group and lobectomy group,with the mean nodule size of 1.44 cm and 1.49 cm and the mean consolidation tumor ratio(CTR)of 0.46 and 0.52,respectively.There was no statistical difference in DFS rate(P=0.640)or OS rate(P=0.310)between the two groups.Conclusion 3D-guided cone-shaped segmentectomy can be an acceptable treatment for low-grade malignant NSCLC deep in lung parenchyma with diameter≤2 cm,and its oncology effect is not inferior to lobectomy.