{"title":"c-IA 非小细胞肺癌患者分段切除术后的局部区域复发模式和时间。","authors":"Hironobu Wada, Hidemi Suzuki, Takahide Toyoda, Yuki Sata, Terunaga Inage, Kazuhisa Tanaka, Yuichi Sakairi, Yukiko Matsui, Shigetoshi Yoshida, Ichiro Yoshino","doi":"10.21037/jtd-24-783","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Segmentectomy has been recognized as the standard procedure for small peripheral lung cancer; however, it has been shown that loco-regional relapse is more common with segmentectomy than with lobectomy. This study aims to investigate the long-term outcomes and loco-regional relapse patterns in patients with clinical stage IA (c-IA) non-small cell lung cancer (NSCLC) after segmentectomy and compare them with those after lobectomy.</p><p><strong>Methods: </strong>We retrospectively compared the long-term outcomes of 115 patients who underwent segmentectomy for c-IA NSCLC with those of 292 patients who underwent lobectomy between January 2008 and December 2015. Segmentectomy was indicated intentionally or chosen in patients who were considered intolerable to lobectomy. New isolated growing lung lesions were defined as relapses if they were not diagnosed with a second primary lung cancer.</p><p><strong>Results: </strong>The median observation period was 2,150 days. The 10-year overall survival (OS) rates and relapse-free survival (RFS) rates of the two groups were similar: 79.4% and 68.7% for segmentectomy, and 68.2% and 61.2% for lobectomy. Even after propensity score matching, no significant differences were observed in the OS and RFS rates between the groups. The segmentectomy group had a higher loco-regional relapse rate (14% <i>vs</i>. 8%), including the surgical margin, remnant lobe, ipsilateral lung, mediastinal lymph node, and ipsilateral dissemination; however, no relapse was observed in the ipsilateral hilar lymph node. Loco-regional relapse occurred significantly later after segmentectomy than after lobectomy (median: 1,246 <i>vs</i>. 512 days, P=0.03), especially four years after segmentectomy. Loco-regional relapse occurred even when the tumor diameter was <1.0 cm. Most patients with loco-regional relapse had solid-dominant tumors.</p><p><strong>Conclusions: </strong>Segmentectomy, both intentional and compromised, showed comparable long-term outcomes to lobectomy; however, loco-regional relapse can develop in a later phase than lobectomy, requiring careful follow-up.</p>","PeriodicalId":17542,"journal":{"name":"Journal of thoracic disease","volume":"16 11","pages":"7511-7525"},"PeriodicalIF":2.1000,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635250/pdf/","citationCount":"0","resultStr":"{\"title\":\"Loco-regional relapse pattern and timing after segmentectomy in patients with c-IA non-small cell lung cancer.\",\"authors\":\"Hironobu Wada, Hidemi Suzuki, Takahide Toyoda, Yuki Sata, Terunaga Inage, Kazuhisa Tanaka, Yuichi Sakairi, Yukiko Matsui, Shigetoshi Yoshida, Ichiro Yoshino\",\"doi\":\"10.21037/jtd-24-783\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Segmentectomy has been recognized as the standard procedure for small peripheral lung cancer; however, it has been shown that loco-regional relapse is more common with segmentectomy than with lobectomy. This study aims to investigate the long-term outcomes and loco-regional relapse patterns in patients with clinical stage IA (c-IA) non-small cell lung cancer (NSCLC) after segmentectomy and compare them with those after lobectomy.</p><p><strong>Methods: </strong>We retrospectively compared the long-term outcomes of 115 patients who underwent segmentectomy for c-IA NSCLC with those of 292 patients who underwent lobectomy between January 2008 and December 2015. Segmentectomy was indicated intentionally or chosen in patients who were considered intolerable to lobectomy. New isolated growing lung lesions were defined as relapses if they were not diagnosed with a second primary lung cancer.</p><p><strong>Results: </strong>The median observation period was 2,150 days. The 10-year overall survival (OS) rates and relapse-free survival (RFS) rates of the two groups were similar: 79.4% and 68.7% for segmentectomy, and 68.2% and 61.2% for lobectomy. Even after propensity score matching, no significant differences were observed in the OS and RFS rates between the groups. The segmentectomy group had a higher loco-regional relapse rate (14% <i>vs</i>. 8%), including the surgical margin, remnant lobe, ipsilateral lung, mediastinal lymph node, and ipsilateral dissemination; however, no relapse was observed in the ipsilateral hilar lymph node. Loco-regional relapse occurred significantly later after segmentectomy than after lobectomy (median: 1,246 <i>vs</i>. 512 days, P=0.03), especially four years after segmentectomy. Loco-regional relapse occurred even when the tumor diameter was <1.0 cm. Most patients with loco-regional relapse had solid-dominant tumors.</p><p><strong>Conclusions: </strong>Segmentectomy, both intentional and compromised, showed comparable long-term outcomes to lobectomy; however, loco-regional relapse can develop in a later phase than lobectomy, requiring careful follow-up.</p>\",\"PeriodicalId\":17542,\"journal\":{\"name\":\"Journal of thoracic disease\",\"volume\":\"16 11\",\"pages\":\"7511-7525\"},\"PeriodicalIF\":2.1000,\"publicationDate\":\"2024-11-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635250/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of thoracic disease\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.21037/jtd-24-783\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/11/22 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"RESPIRATORY SYSTEM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of thoracic disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.21037/jtd-24-783","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/11/22 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
Loco-regional relapse pattern and timing after segmentectomy in patients with c-IA non-small cell lung cancer.
Background: Segmentectomy has been recognized as the standard procedure for small peripheral lung cancer; however, it has been shown that loco-regional relapse is more common with segmentectomy than with lobectomy. This study aims to investigate the long-term outcomes and loco-regional relapse patterns in patients with clinical stage IA (c-IA) non-small cell lung cancer (NSCLC) after segmentectomy and compare them with those after lobectomy.
Methods: We retrospectively compared the long-term outcomes of 115 patients who underwent segmentectomy for c-IA NSCLC with those of 292 patients who underwent lobectomy between January 2008 and December 2015. Segmentectomy was indicated intentionally or chosen in patients who were considered intolerable to lobectomy. New isolated growing lung lesions were defined as relapses if they were not diagnosed with a second primary lung cancer.
Results: The median observation period was 2,150 days. The 10-year overall survival (OS) rates and relapse-free survival (RFS) rates of the two groups were similar: 79.4% and 68.7% for segmentectomy, and 68.2% and 61.2% for lobectomy. Even after propensity score matching, no significant differences were observed in the OS and RFS rates between the groups. The segmentectomy group had a higher loco-regional relapse rate (14% vs. 8%), including the surgical margin, remnant lobe, ipsilateral lung, mediastinal lymph node, and ipsilateral dissemination; however, no relapse was observed in the ipsilateral hilar lymph node. Loco-regional relapse occurred significantly later after segmentectomy than after lobectomy (median: 1,246 vs. 512 days, P=0.03), especially four years after segmentectomy. Loco-regional relapse occurred even when the tumor diameter was <1.0 cm. Most patients with loco-regional relapse had solid-dominant tumors.
Conclusions: Segmentectomy, both intentional and compromised, showed comparable long-term outcomes to lobectomy; however, loco-regional relapse can develop in a later phase than lobectomy, requiring careful follow-up.
期刊介绍:
The Journal of Thoracic Disease (JTD, J Thorac Dis, pISSN: 2072-1439; eISSN: 2077-6624) was founded in Dec 2009, and indexed in PubMed in Dec 2011 and Science Citation Index SCI in Feb 2013. It is published quarterly (Dec 2009- Dec 2011), bimonthly (Jan 2012 - Dec 2013), monthly (Jan. 2014-) and openly distributed worldwide. JTD received its impact factor of 2.365 for the year 2016. JTD publishes manuscripts that describe new findings and provide current, practical information on the diagnosis and treatment of conditions related to thoracic disease. All the submission and reviewing are conducted electronically so that rapid review is assured.