Prognosis of non-small cell lung cancer patients undergoing compromised wedge vs. segmental resection: a population-based cohort study.

IF 1.5 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiothoracic Surgery Pub Date : 2025-08-12 DOI:10.1186/s13019-025-03578-5

Shengchao Zhang, Suoming Peng, Long Zhang, Qingshou Luo, Bingchuan Dai, Hongwei Xia, Chunling Du

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引用次数: 0

Abstract

Background: Sublobar resection (SLR), which includes wedge resection (WR) and segmental resection (SR), is often considered a compromised procedure for non-small cell lung cancer (NSCLC) patients who have limited pulmonary reserve or other conditions that cannot tolerate lobectomy. This study intends to evaluate and compare the results of WR and SR on overall survival (OS) in patients undergoing compromised SLR.

Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) database was analyzed, identifing 2,047 patients with pathological stage (pStage) IB-IIIB NSCLC who underwent compromised SLR, including WR and SR. The two treatment groups' potential baseline differences were balanced using propensity score matching (PSM). Univariate and multivariate analyses were conducted to determine the impact of procedures on OS before PSM. Kaplan-Meier (KM) analysis calculated survival curves and compared OS across groups before and after PSM. Subgroup analysis investigated the influence of surgical procedures on OS within specific patient subgroups after PSM. Additionally, a sensitivity analysis focusing on patients with T1 and T2 stages was performed after PSM to validate the robustness of the results.

Results: Overall, 421 patients (20.57%) underwent SR. In univariate analysis, SR was associated with improved OS as compared to WR (HR = 0.85; 95% CI: 0.75-0.97; P = 0.02). Nevertheless, the association did not last in the multivariate analysis (HR = 0.94; 95% CI: 0.82-1.07; P = 0.32). Following PSM, KM analysis also revealed no significant difference in OS (P = 0.21). A subgroup analysis revealed that SR provided a marginal improvement in OS for patients under the age of 60. However, this impact was only borderline statistically significant (HR = 0.49; 95% CI: 0.23-1.03; P = 0.059), and no relevant link was observed in other groups. Additionally, a sensitivity analysis demonstrated no significant association between SR and OS (HR = 0.91; 95% CI: 0.73-1.13; P = 0.39).

Conclusions: The benefit of SR over WR in compromised SLR for NSCLC patients may be limited. Further studies are necessary to clarify the optimal surgical approach for different patient subgroups.

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非小细胞肺癌患者行楔形与节段切除的预后：一项基于人群的队列研究

背景：叶下切除术（SLR），包括楔形切除术（WR）和节段性切除术（SR），通常被认为是肺储备有限或其他条件不能耐受肺叶切除术的非小细胞肺癌（NSCLC）患者的妥协手术。本研究旨在评估和比较WR和SR对SLR受损患者总生存（OS）的影响。方法：对来自监测、流行病学和最终结果（SEER）数据库的数据进行分析，确定2047例病理期（pStage） IB-IIIB NSCLC患者的SLR受损，包括WR和sr。使用倾向评分匹配（PSM）平衡两个治疗组的潜在基线差异。进行单因素和多因素分析以确定PSM前手术对OS的影响。Kaplan-Meier （KM）分析计算生存曲线，比较各组PSM前后的OS。亚组分析调查了PSM后特定患者亚组中手术对OS的影响。此外，对PSM后T1期和T2期患者进行敏感性分析，以验证结果的稳健性。结果：总体而言，421例患者（20.57%）接受了SR。在单因素分析中，与WR相比，SR与改善的OS相关(HR = 0.85；95% ci: 0.75-0.97；p = 0.02)。然而，在多变量分析中，这种关联并没有持续下去(HR = 0.94；95% ci: 0.82-1.07；p = 0.32)。PSM后，KM分析也显示OS无显著差异（P = 0.21）。亚组分析显示，对于60岁以下的患者，SR提供了OS的边际改善。然而，这种影响仅具有临界统计学意义(HR = 0.49；95% ci: 0.23-1.03；P = 0.059)，其余各组无相关联系。此外，敏感性分析显示SR和OS之间无显著相关性(HR = 0.91；95% ci: 0.73-1.13；p = 0.39)。结论：非小细胞肺癌患者SLR受损时，SR优于WR的益处可能有限。需要进一步的研究来明确不同患者亚群的最佳手术入路。

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

Journal of Cardiothoracic Surgery 医学-心血管系统

CiteScore

2.50

自引率

6.20%

发文量

286

审稿时长

4-8 weeks

期刊介绍： Journal of Cardiothoracic Surgery is an open access journal that encompasses all aspects of research in the field of Cardiology, and Cardiothoracic and Vascular Surgery. The journal publishes original scientific research documenting clinical and experimental advances in cardiac, vascular and thoracic surgery, and related fields. Topics of interest include surgical techniques, survival rates, surgical complications and their outcomes; along with basic sciences, pediatric conditions, transplantations and clinical trials. Journal of Cardiothoracic Surgery is of interest to cardiothoracic and vascular surgeons, cardiothoracic anaesthesiologists, cardiologists, chest physicians, and allied health professionals.