Tumour spread through air spaces is a determiner for treatment of clinical stage I non-small cell lung Cancer: Thoracoscopic segmentectomy vs lobectomy

IF 4.4 2区医学 Q1 ONCOLOGY Lung Cancer Pub Date : 2025-03-01 Epub Date: 2025-02-07 DOI:10.1016/j.lungcan.2025.108438

Lin Huang, René Horsleben Petersen

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Abstract

Background

The choice of surgical procedure for early-stage non-small cell lung cancer (NSCLC) with tumour spread through air spaces (STAS) remain debated. This study aimed to analyse the prognostic influence of STAS on thoracoscopic segmentectomy compared to lobectomy for clinical stage I NSCLC.

Methods

This retrospective study included prospectively collected data of consecutive patients who underwent thoracoscopic segmentectomy or lobectomy for clinical stage I NSCLC from September 2020 to September 2023 at a high-volume hospital. We assessed overall survival (OS) and recurrence-free survival (RFS) using Kaplan-Meier estimator with log-rank test. LASSO-Cox and Cox regression analyses identified independent factors for survivals of STAS presence.

Results

Among the 785 patients in the study, 151 (19.2 %) had STAS-positive NSCLC. No significant difference was observed in OS and RFS between patients with the presence and absence of STAS, nor between those undergoing thoracoscopic segmentectomy and lobectomy for NSCLC in the absence of STAS. Whereas worse survivals were found in segmentectomy for patients with STAS when compared to lobectomy (3-year OS: 58.4 % vs 89.0 %, P < 0.001; 3-year RFS: 69.8 % vs 82.7 %, P < 0.001). On multivariable analysis, segmentectomy (vs. lobectomy) and increased maximum standardized uptake value in positron emission tomography were independent prognostic factors of OS (hazard ratio [HR] 5.81, P = 0.010; HR 1.12, P = 0.022) and RFS (HR 5.78, P = 0.004; HR 1.10, P = 0.025) among patients with STAS.

Conclusions

In this study, segmentectomy for clinical stage I NSCLC with STAS had inferior RFS and OS when compared to lobectomy.

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肿瘤通过空气扩散是临床I期非小细胞肺癌治疗的决定因素：胸腔镜节段切除术与肺叶切除术

背景：对于早期非小细胞肺癌（NSCLC）通过空气间隙扩散（STAS）的手术治疗选择仍有争议。本研究旨在分析STAS对临床I期NSCLC胸腔镜节段切除术与肺叶切除术预后的影响。方法本回顾性研究前瞻性收集了2020年9月至2023年9月在一家大容量医院接受胸腔镜肺段切除术或肺叶切除术治疗临床I期NSCLC的连续患者的数据。我们使用Kaplan-Meier估计和log-rank检验评估总生存期（OS）和无复发生存期（RFS）。LASSO-Cox和Cox回归分析确定了影响STAS存活的独立因素。结果在785例患者中，151例（19.2%）为stas阳性NSCLC。存在和不存在STAS的患者的OS和RFS没有显著差异，在没有STAS的NSCLC胸腔镜节段切除术和肺叶切除术之间也没有显著差异。然而，与肺叶切除术相比，STAS患者的节段切除术生存率更低(3年OS: 58.4% vs 89.0%, P <；0.001;3年RFS: 69.8% vs 82.7%, P <；0.001)。在多变量分析中，节段切除术（相对于肺叶切除术）和正电子发射断层扫描最大标准化摄取值的增加是OS的独立预后因素(风险比[HR] 5.81, P = 0.010；HR 1.12, P = 0.022)和RFS (HR 5.78, P = 0.004；HR 1.10, P = 0.025)。结论在本研究中，与肺叶切除术相比，临床I期NSCLC伴STAS的节段切除术的RFS和OS较差。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Lung Cancer 医学-呼吸系统

CiteScore

9.40

自引率

3.80%

发文量

407

审稿时长

25 days

期刊介绍： Lung Cancer is an international publication covering the clinical, translational and basic science of malignancies of the lung and chest region.Original research articles, early reports, review articles, editorials and correspondence covering the prevention, epidemiology and etiology, basic biology, pathology, clinical assessment, surgery, chemotherapy, radiotherapy, combined treatment modalities, other treatment modalities and outcomes of lung cancer are welcome.