小径肺腺癌における亜葉切除術の最適性：微小乳頭癌または充実性組織学的成分を有する2cm以下の末梢性結節を対象とした検討
Yuanyuan Xu1, Zhongjie Wang2, Hanbo Pan1
1Department of thoracic surgery, Shanghai Chest Hospital Affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Background:
The optimal extent of resection for small peripheral nonmucinous invasive lung adenocarcinoma with high-risk histologic features remains uncertain. Although sublobar resection is increasingly accepted for selected early-stage tumors, its adequacy for nonmucinous invasive lung adenocarcinoma harboring micropapillary or solid histologic components are not well defined.
Methods:
We conducted a retrospective single-center cohort study of 501 patients with peripheral non-mucinous invasive lung adenocarcinoma ≤2 cm (pN0M0) containing micropapillary or solid histologic components who underwent lobectomy or sublobar resection between 2018 and 2020. Recurrence-free survival (RFS) and lung cancer-specific survival (LCSS) were analyzed using Kaplan-Meier methods and Cox proportional hazards models. Propensity-score matching was performed as a sensitivity analysis to adjust for baseline differences.
Results:
Lobectomy was associated with higher 5-year RFS and LCSS compared with sublobar resection (log-rank p<0.001). These associations remained consistent after propensity-score matching. In matched analyses, consolidation-to-tumor ratio (CTR) >0.5, visceral pleural invasion, wedge resection, and segmentectomy were independently associated with worse LCSS and RFS compared with lobectomy.
Conclusions:
In this single-center retrospective cohort, lobectomy was associated with more favorable outcomes than sublobar resection among ≤ 2 cm peripheral nonmucinous invasive lung adenocarcinoma harboring micropapillary or solid histology components. However, these findings are hypothesis-generating and require prospective validation.
