Impact of Margin Distance on Locoregional Recurrence and Survival After Thoracoscopic Segmentectomy.

IF 3.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery Pub Date : 2025-02-01 Epub Date: 2024-07-25 DOI:10.1016/j.athoracsur.2024.07.012

Lin Huang, René Horsleben Petersen

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引用次数: 0

Abstract

Background: This study aimed to identify the impact of margin distance on locoregional recurrence (LRR) and survival outcomes after thoracoscopic segmentectomy for non-small cell lung cancer.

Methods: We retrospectively analyzed data from prospectively collected consecutive thoracoscopic segmentectomies in a single center from January 2008 to February 2023. The restricted cubic spline of the adjusted Cox regression model for LRR displayed the breakpoint of margin distance. The Kaplan-Meier estimator with log-rank test evaluated the overall survival between the 2 groups stratified by the breakpoint, and the Aalen-Johansen estimator with the Gray test assessed the LRR-free survival and lung cancer-specific survival in the competing model.

Results: The study included 155 patients. LRR was observed in 22 patients (14.2%), with a median time to LRR of 17.1 months (interquartile range, 6.3-26.3 months). Margin distance was found to be a predictor for LRR (hazard ratio, 0.92; P = .033). The identified breakpoint for margin distance in this cohort was 19.8 mm. Compared with this cutoff, a margin distance of 15 mm increased the risk of LRR by 65%, whereas 25 mm decreased the risk to LRR with 31%. A segmentectomy with a margin distance ≥20 mm resulted in significant improvements in overall survival (P = .020), lung cancer-specific survival (P = .010), and LRR-free survival (P < .001) compared with cases with a margin distance of <20 mm.

Conclusions: Margin distance ≥20 mm decreased LRR and improved survival outcomes for thoracoscopic segmentectomy in this study.

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胸腔镜分段切除术后边缘距离对局部区域复发和存活率的影响

背景：本研究旨在确定边缘距离对非小细胞肺癌胸腔镜分段切除术后局部区域复发（LRR）和生存结果的影响：本研究旨在确定边缘距离对非小细胞肺癌胸腔镜分段切除术后局部区域复发（LRR）和生存结果的影响：我们回顾性分析了2008年1月至2023年2月期间在一个中心连续进行的胸腔镜肺段切除术的前瞻性数据。LRR 的调整 Cox 回归模型的受限立方样条显示了边缘距离的断点。Kaplan-Meier估计器与对数秩检验评估了按断点分层的两组总生存率，Aalen-Johansen估计器与格雷检验评估了竞争模型中无LRR生存率和肺癌特异性生存率：研究共纳入了 155 例患者。22例患者（14.2%）观察到LRR，中位LRR时间为17.1个月（四分位间范围6.3-26.3）。研究发现，边缘距离是 LRR 的预测因素（危险比 0.92，P = .033）。该队列中确定的边缘距离分界点为 19.8 毫米。与此分界点相比，边缘距离为 15 毫米时，LRR 风险增加 65%，而 25 毫米时，LRR 风险降低 31%。与边缘距离小于20毫米的病例相比，边缘距离≥20毫米的分段切除术可显著提高总生存率（P = .020）、肺癌特异性生存率（P = .010）和无LRR生存率（P < .001）：结论：在本研究中，边缘距离≥ 20 毫米可降低胸腔镜肺段切除术的 LRR，改善生存结果。

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

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.