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Article(id=1245407865092031167, tenantId=1146029695717560320, journalId=1146123166801305609, issueId=1156262727438951343, articleNumber=null, orderNo=null, doi=10.12404/j.issn.1671-1815.2500464, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1737129600000, receivedDateStr=2025-01-18, revisedDate=1740499200000, revisedDateStr=2025-02-26, acceptedDate=null, acceptedDateStr=null, onlineDate=1774857973596, onlineDateStr=2026-03-30, pubDate=1741363200000, pubDateStr=2025-03-08, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1774857973596, onlineIssueDateStr=2026-03-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1774857973596, creator=13701087609, updateTime=1774857973596, updator=13701087609, issue=Issue{id=1156262727438951343, tenantId=1146029695717560320, journalId=1146123166801305609, year='2025', volume='25', issue='7', pageStart='2193', pageEnd='3077', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1753604116544, creator=13701087609, updateTime=1753771263994, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1156963794699248405, tenantId=1146029695717560320, journalId=1146123166801305609, issueId=1156262727438951343, language=EN, specialIssueTitle=, coverIllustrator=, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1156963794699248406, tenantId=1146029695717560320, journalId=1146123166801305609, issueId=1156262727438951343, language=CN, specialIssueTitle=, coverIllustrator=, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2732, endPage=2740, ext={EN=ArticleExt(id=1245407865817645833, articleId=1245407865092031167, tenantId=1146029695717560320, journalId=1146123166801305609, language=EN, title=Long-term Survival Comparison of Sublobar Resection Versus Lobectomy in Early-stage Non-small Cell Lung Cancer Patients(T≤3 cm N0M0) with Visceral Pleural Invasion, columnId=1156262732384031076, journalTitle=Science Technology and Engineering, columnName=Papers·Medicine, runingTitle=null, highlight=null, articleAbstract=

Recent studies indicate that for early-stage non-small cell lung cancer(NSCLC) classified as T1N0M0, sublobar resection offers long-term outcomes comparable to lobectomy. However, these early-stage patients may still experience pleural invasion, which is associated with poor prognosis. It is necessary to compare the long-term efficacy of sublobar resection versus lobectomy in patients with T≤3 cm N0M0 NSCLC accompanied by pleural invasion. Research data were sourced from the SEER(Surveillance, Epidemiology, and End Results) database. Patients diagnosed were from between 2010 and 2020 with T≤3 cm N0M0 NSCLC and pleural invasion. Patients were divided into sublobar resection and lobectomy groups, and their cancer-specific survival(CSS) and overall survival(OS) were compared. Univariate analysis post-matching reveale no significant differences in CSS and OS between the sublobar resection and lobectomy groups. Multivariate analysis also indicate that the surgical approach is not an independent prognostic factor for CSS(HR=1.185, 95% CI: 0.745~1.885, P=0.472) and OS (HR=1.171, 95% CI: 0.869~1.577, P=0.299)in patients with T≤3 cm N0M0 NSCLC and pleural invasion. Subgroup analyses show no significant differences in CSS and OS between the two groups across various subgroups. Competing risk model multivariate analysis also demonstrate no significant difference in lung cancer-specific mortality between sublobar resection and lobectomy. In conclusion, for patients with T≤3 cm N0M0 NSCLC accompanied by pleural invasion, sublobar resection offers long-term survival outcomes comparable to lobectomy and can be considered a viable surgical option for this patient population.

, correspAuthors=Hong-chao XIONG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, authorCompany=null, fund=null, authors=null, authorsList=Hao FU, Yong-bo YANG, Zhen LIANG, Hong-chao XIONG), CN=ArticleExt(id=1245407870884364580, articleId=1245407865092031167, tenantId=1146029695717560320, journalId=1146123166801305609, language=CN, title=亚肺叶切除与肺叶切除在T≤3 cm N0M0合并胸膜侵犯的早期非小细胞肺癌患者中的远期生存比较, columnId=1156262732526637414, journalTitle=科学技术与工程, columnName=论文·医药、卫生, runingTitle=null, highlight=null, articleAbstract=

目前研究表明对于分期为T1N0M0的早期非小细胞肺癌,亚肺叶切除的远期疗效不亚于肺叶切除术。但这部分早期肺癌患者仍有可能发生胸膜侵犯,胸膜侵犯与不良预后相关。为此,需对比分析亚肺叶切除和肺叶切除对T≤3 cm N0M0合并胸膜侵犯的非小细胞肺癌患者的远期疗效。现基于SEER(Surveillance, Epidemiology, and End Results)数据库,将2010—2020年肿瘤分期为T≤3 cm N0M0伴有胸膜侵犯的非小细胞肺癌患者分为亚肺叶切除组和肺叶切除组,比较两组患者的肿瘤特异性生存(cancer specific survival, CSS)和总生存(overall survival, OS)。倾向性评分匹配后的单因素分析显示,亚肺叶切除与肺叶切除的CSS和OS均无显著差异。多因素分析亦显示,手术方式并非T≤3 cm N0M0合并胸膜侵犯的非小细胞肺癌患者CSS(HR=1.185, 95%CI: 0.745~1.885, P=0.472)和OS(HR=1.171, 95%CI: 0.869~1.577, P=0.299)的独立的预后因素。亚组分析显示,在各亚组中,两组的CSS和OS均无显著差异。竞争风险模型多因素亦显示,亚肺叶切除与肺叶切除的肺癌特异性死亡率无显著差异。对于分期为T≤3 cm N0M0合并胸膜侵犯的非小细胞肺癌患者,亚肺叶切除的远期生存与肺叶切除相当,可作为该患者群体的手术方式选择。

, correspAuthors=熊宏超, authorNote=null, correspAuthorsNote=
* 熊宏超(1972—),男,汉族,北京人,博士。研究方向:胸部肿瘤学。E-mail:。
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付浩(1985—),男,汉族,湖北汉川人,博士。研究方向:胸部肿瘤学。E-mail:。

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付浩(1985—),男,汉族,湖北汉川人,博士。研究方向:胸部肿瘤学。E-mail:。

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付浩(1985—),男,汉族,湖北汉川人,博士。研究方向:胸部肿瘤学。E-mail:。

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The Journal of Thoracic and Cardiovascular Surgery, 2021, 161(5): 1639-1648., articleTitle=Outcomes with segmentectomy versus lobectomy in patients with clinical T1cN0M0 non-small cell lung cancer, refAbstract=null)], funds=[Fund(id=1245407876567646979, tenantId=1146029695717560320, journalId=1146123166801305609, articleId=1245407865092031167, awardId=2021YFC2500900, language=CN, fundingSource=国家重点研发计划(2021YFC2500900), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1245407871328960832, tenantId=1146029695717560320, journalId=1146123166801305609, articleId=1245407865092031167, xref=null, ext=[AuthorCompanyExt(id=1245407871333155138, tenantId=1146029695717560320, journalId=1146123166801305609, articleId=1245407865092031167, companyId=1245407871328960832, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Thoracic Surgery, Peking University Cancer Hospital, Beijing 100142, China), AuthorCompanyExt(id=1245407871341543748, tenantId=1146029695717560320, journalId=1146123166801305609, articleId=1245407865092031167, companyId=1245407871328960832, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=北京大学肿瘤医院胸部肿瘤外一科, 北京 100142)])], figs=[ArticleFig(id=1245407874168504893, tenantId=1146029695717560320, journalId=1146123166801305609, articleId=1245407865092031167, language=EN, label=Fig.1, caption=Patient enrollment flowchart, figureFileSmall=tWlPdPjMi13R5PaZPAEaKw==, figureFileBig=5Zu/HYcFfn8DRzD6h/QVPg==, tableContent=null), ArticleFig(id=1245407874311111248, tenantId=1146029695717560320, journalId=1146123166801305609, articleId=1245407865092031167, language=CN, label=图1, caption=患者入组流程, figureFileSmall=tWlPdPjMi13R5PaZPAEaKw==, figureFileBig=5Zu/HYcFfn8DRzD6h/QVPg==, tableContent=null), ArticleFig(id=1245407874558575202, tenantId=1146029695717560320, journalId=1146123166801305609, articleId=1245407865092031167, language=EN, label=Fig.2, caption=Survival comparison of different surgical approaches, figureFileSmall=hAGTptE+PhxgQI8a2lv2Fg==, figureFileBig=C4FSPGOMhdeDlKoMgcAZYg==, tableContent=null), ArticleFig(id=1245407874663432815, tenantId=1146029695717560320, journalId=1146123166801305609, articleId=1245407865092031167, language=CN, label=图2, caption=不同手术方式的生存比较, figureFileSmall=hAGTptE+PhxgQI8a2lv2Fg==, figureFileBig=C4FSPGOMhdeDlKoMgcAZYg==, tableContent=null), ArticleFig(id=1245407874776679027, tenantId=1146029695717560320, journalId=1146123166801305609, articleId=1245407865092031167, language=EN, label=Fig.3, caption=Comparison of cancer specific survival between sublobar resection and lobectomy in different subgroups, figureFileSmall=CAvz7EsNe2xeDIJfZQ4/Kw==, figureFileBig=GVRlzQpi1XqMpqxpGohCNQ==, tableContent=null), ArticleFig(id=1245407874948645502, tenantId=1146029695717560320, journalId=1146123166801305609, articleId=1245407865092031167, language=CN, label=图3, caption=亚肺叶切除和肺叶切除在不同亚组的肿瘤特异性生存比较, figureFileSmall=CAvz7EsNe2xeDIJfZQ4/Kw==, figureFileBig=GVRlzQpi1XqMpqxpGohCNQ==, tableContent=null), ArticleFig(id=1245407875074474632, tenantId=1146029695717560320, journalId=1146123166801305609, articleId=1245407865092031167, language=EN, label=Fig.4, caption=Comparison of overall survival between sublobar resection and lobectomy in different subgroups, figureFileSmall=69co/YUOpkbjMf333evSEg==, figureFileBig=rV55FZI8UqW61Ussi/xzPQ==, tableContent=null), ArticleFig(id=1245407875242246806, tenantId=1146029695717560320, journalId=1146123166801305609, articleId=1245407865092031167, language=CN, label=图4, caption=亚肺叶切除和肺叶切除在不同亚组得总生存比较, figureFileSmall=69co/YUOpkbjMf333evSEg==, figureFileBig=rV55FZI8UqW61Ussi/xzPQ==, tableContent=null), ArticleFig(id=1245407875372270241, tenantId=1146029695717560320, journalId=1146123166801305609, articleId=1245407865092031167, language=EN, label=Fig.5, caption=Competing risk analysis of cancer specific mortality in patients with T≤3 cm N0M0 lung cancer with pleural invasion, figureFileSmall=6E+ifli+cd5ctug4dGTayA==, figureFileBig=uqzzMyc6VrW+spVyp4V+GQ==, tableContent=null), ArticleFig(id=1245407875472933545, tenantId=1146029695717560320, journalId=1146123166801305609, articleId=1245407865092031167, language=CN, label=图5, caption=T≤3 cm N0M0伴胸膜侵犯肺癌患者的肿瘤特异性死亡率的竞争风险分析, figureFileSmall=6E+ifli+cd5ctug4dGTayA==, figureFileBig=uqzzMyc6VrW+spVyp4V+GQ==, tableContent=null), ArticleFig(id=1245407875573596852, tenantId=1146029695717560320, journalId=1146123166801305609, articleId=1245407865092031167, language=EN, label=Table 1, caption=

Comparison of baseline clinical characteristics between the sublobar resection group and the lobectomy group before and after propensity score matching

, figureFileSmall=null, figureFileBig=null, tableContent=
项目 匹配前 匹配后
肺叶切除(n=1 526)
病例(占比/%)		 亚肺叶切除(n=392)
病例(占比/%)		 P 肺叶切除(n=341)
病例(占比/%)		 亚肺叶切除(n=341)
病例(占比/%)		 P
性别 0.68 0.757
女性 892(58.5) 224(57.1) 190(55.7) 195(57.2)
男性 634(41.5) 168(42.9) 151(44.3) 146(42.8)
年龄 0.005 0.698
≤68岁 751(49.2) 161(41.1) 139(40.8) 145(42.5)
>68岁 775(50.8) 231(58.9) 202(59.2) 196(57.5)
种族 <0.001 0.57
白人 1 172(76.8) 338(86.2) 303(88.9) 294(86.2)
亚洲人和其他 205(13.4) 23(5.9) 17(5.0) 22(6.5)
黑人 149(9.8) 31(7.9) 21(6.2) 25(7.3)
诊断时间段 0.401 0.743
2010—2015年 555(36.4) 133(33.9) 108(31.7) 113(33.1)
2016—2020年 971(63.6) 259(66.1) 233(68.3) 228(66.9)
肿瘤位置 <0.001 0.964
左肺下叶 199(13.0) 62(15.8) 47(13.8) 50(14.7)
左肺上叶 373(24.4) 124(31.6) 112(32.8) 105(30.8)
右肺下叶 245(16.1) 72(18.4) 58(17.0) 60(17.6)
右肺中叶 107(7.0) 11(2.8) 13(3.8) 11(3.2)
右肺上叶 602(39.4) 123(31.4) 111(32.6) 115(33.7)
肿瘤大小 <0.001 0.189
1~10 mm 58(3.8) 34(8.7) 16(4.7) 26(7.6)
11~20 mm 669(43.8) 212(54.1) 199(58.4) 182(53.4)
21~30 mm 799(52.4) 146(37.2) 126(37.0) 133(39.0)
病理类型 0.202 0.981
腺癌 1 245(81.6) 302(77.0) 270(79.2) 267(78.3)
鳞癌 222(14.5) 71(18.1) 56(16.4) 57(16.7)
腺鳞癌 42(2.8) 12(3.1) 11(3.2) 12(3.5)
其他 17(1.1) 7(1.8) 4(1.2) 5(1.5)
淋巴结切除数目 <0.001 0.715
1~3枚 170(11.1) 124(31.6) 75(22.0) 80(23.5)
≥4枚 1 356(88.9) 268(68.4) 266(78.0) 261(76.5)
), ArticleFig(id=1245407875728786111, tenantId=1146029695717560320, journalId=1146123166801305609, articleId=1245407865092031167, language=CN, label=表1, caption=

倾向性评分匹配前后亚肺叶切除组与肺叶切除组基本临床信息比较

, figureFileSmall=null, figureFileBig=null, tableContent=
项目 匹配前 匹配后
肺叶切除(n=1 526)
病例(占比/%)		 亚肺叶切除(n=392)
病例(占比/%)		 P 肺叶切除(n=341)
病例(占比/%)		 亚肺叶切除(n=341)
病例(占比/%)		 P
性别 0.68 0.757
女性 892(58.5) 224(57.1) 190(55.7) 195(57.2)
男性 634(41.5) 168(42.9) 151(44.3) 146(42.8)
年龄 0.005 0.698
≤68岁 751(49.2) 161(41.1) 139(40.8) 145(42.5)
>68岁 775(50.8) 231(58.9) 202(59.2) 196(57.5)
种族 <0.001 0.57
白人 1 172(76.8) 338(86.2) 303(88.9) 294(86.2)
亚洲人和其他 205(13.4) 23(5.9) 17(5.0) 22(6.5)
黑人 149(9.8) 31(7.9) 21(6.2) 25(7.3)
诊断时间段 0.401 0.743
2010—2015年 555(36.4) 133(33.9) 108(31.7) 113(33.1)
2016—2020年 971(63.6) 259(66.1) 233(68.3) 228(66.9)
肿瘤位置 <0.001 0.964
左肺下叶 199(13.0) 62(15.8) 47(13.8) 50(14.7)
左肺上叶 373(24.4) 124(31.6) 112(32.8) 105(30.8)
右肺下叶 245(16.1) 72(18.4) 58(17.0) 60(17.6)
右肺中叶 107(7.0) 11(2.8) 13(3.8) 11(3.2)
右肺上叶 602(39.4) 123(31.4) 111(32.6) 115(33.7)
肿瘤大小 <0.001 0.189
1~10 mm 58(3.8) 34(8.7) 16(4.7) 26(7.6)
11~20 mm 669(43.8) 212(54.1) 199(58.4) 182(53.4)
21~30 mm 799(52.4) 146(37.2) 126(37.0) 133(39.0)
病理类型 0.202 0.981
腺癌 1 245(81.6) 302(77.0) 270(79.2) 267(78.3)
鳞癌 222(14.5) 71(18.1) 56(16.4) 57(16.7)
腺鳞癌 42(2.8) 12(3.1) 11(3.2) 12(3.5)
其他 17(1.1) 7(1.8) 4(1.2) 5(1.5)
淋巴结切除数目 <0.001 0.715
1~3枚 170(11.1) 124(31.6) 75(22.0) 80(23.5)
≥4枚 1 356(88.9) 268(68.4) 266(78.0) 261(76.5)
), ArticleFig(id=1245407875883975375, tenantId=1146029695717560320, journalId=1146123166801305609, articleId=1245407865092031167, language=EN, label=Table 2, caption=

Multivariate analysis of cancer-specific survival and overall survival before propensity score matching

, figureFileSmall=null, figureFileBig=null, tableContent=
项目 肿瘤特异性生存 总生存
风险比(95%可信区间) P 风险比(95%可信区间) P
性别
女性 1.00(参照量) 1.00(参照量)
男性 1.390(1.018~1.898) 0.038 1.313(1.086~1.587) 0.004
年龄
≤68岁 1.00(参照量) 1.00(参照量)
>68岁 2.406(1.708~3.388) <0.001 1.691(1.387~2.063) <0.001
种族
其他 1.00(参照量) 1.00(reference)
黑人 1.232(0.538~2.822) 0.620 1.222(0.761~1.960) 0.405
白人 1.485(0.814~2.708) 0.196 1.365(0.965~1.929) 0.077
诊断时间段
2010—2015年 1.00(参照量) 1.00(参照量)
2016—2020年 0.697(0.475~1.023) 0.065 0.577(0.457~0.727) <0.001
肿瘤位置
左肺下叶 1.00(参照量) 1.00(参照量)
左肺上叶 1.161(0.709~1.898) 0.551 1.353(0.982~1.864) 0.063
右肺下叶 1.190(0.687~2.064) 0.533 1.311(0.917~1.876) 0.137
右肺中叶 0.905(0.428~1.914) 0.794 0.896(0.542~1.482) 0.670
右肺上叶 0.776(0.471~1.281) 0.322 1.092(0.796~1.500) 0.583
肿瘤大小
1~10 mm 1.00(参照量) 1.00(参照量)
11~20 mm 1.531(0.662~3.539) 0.318 1.290(0.771~2.159) 0.331
21~30 mm 1.423(0.616~3.288) 0.408 1.569(0.941~2.614) 0.083
病理类型
其他 1.00(参照量) 1.00(参照量)
腺癌 0.625(0.347~1.124) 0.116 0.636(0.441~0.917) 0.015
鳞癌 1.054(0.562~1.977) 0.867 0.920(0.619~1.367) 0.680
淋巴结清扫数目
1~3枚 1.00(参照量) 1.00(参照量)
≥4枚 1.123(0.746~1.691) 0.575 1.012(0.791~1.293) 0.923
手术方式
肺叶切除 1.00(参照量) 1.00(参照量)
亚肺叶切除 1.405(0.969~2.037) 0.072 1.352(1.072~1.705) 0.011
), ArticleFig(id=1245407875997221591, tenantId=1146029695717560320, journalId=1146123166801305609, articleId=1245407865092031167, language=CN, label=表2, caption=

倾向性匹配前肿瘤特异性生存和总生存的多因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
项目 肿瘤特异性生存 总生存
风险比(95%可信区间) P 风险比(95%可信区间) P
性别
女性 1.00(参照量) 1.00(参照量)
男性 1.390(1.018~1.898) 0.038 1.313(1.086~1.587) 0.004
年龄
≤68岁 1.00(参照量) 1.00(参照量)
>68岁 2.406(1.708~3.388) <0.001 1.691(1.387~2.063) <0.001
种族
其他 1.00(参照量) 1.00(reference)
黑人 1.232(0.538~2.822) 0.620 1.222(0.761~1.960) 0.405
白人 1.485(0.814~2.708) 0.196 1.365(0.965~1.929) 0.077
诊断时间段
2010—2015年 1.00(参照量) 1.00(参照量)
2016—2020年 0.697(0.475~1.023) 0.065 0.577(0.457~0.727) <0.001
肿瘤位置
左肺下叶 1.00(参照量) 1.00(参照量)
左肺上叶 1.161(0.709~1.898) 0.551 1.353(0.982~1.864) 0.063
右肺下叶 1.190(0.687~2.064) 0.533 1.311(0.917~1.876) 0.137
右肺中叶 0.905(0.428~1.914) 0.794 0.896(0.542~1.482) 0.670
右肺上叶 0.776(0.471~1.281) 0.322 1.092(0.796~1.500) 0.583
肿瘤大小
1~10 mm 1.00(参照量) 1.00(参照量)
11~20 mm 1.531(0.662~3.539) 0.318 1.290(0.771~2.159) 0.331
21~30 mm 1.423(0.616~3.288) 0.408 1.569(0.941~2.614) 0.083
病理类型
其他 1.00(参照量) 1.00(参照量)
腺癌 0.625(0.347~1.124) 0.116 0.636(0.441~0.917) 0.015
鳞癌 1.054(0.562~1.977) 0.867 0.920(0.619~1.367) 0.680
淋巴结清扫数目
1~3枚 1.00(参照量) 1.00(参照量)
≥4枚 1.123(0.746~1.691) 0.575 1.012(0.791~1.293) 0.923
手术方式
肺叶切除 1.00(参照量) 1.00(参照量)
亚肺叶切除 1.405(0.969~2.037) 0.072 1.352(1.072~1.705) 0.011
), ArticleFig(id=1245407876097884899, tenantId=1146029695717560320, journalId=1146123166801305609, articleId=1245407865092031167, language=EN, label=Table 3, caption=

Multivariate analysis of cancer-specific survival and overall survival after propensity score matching

, figureFileSmall=null, figureFileBig=null, tableContent=
项目 肿瘤特异性生存 总生存
风险比(95%可信区间) P 风险比(95%CI可信区间) P
性别
女性 1.00(参照量) 1.00(参照量)
男性 1.147(0.720~1.826) 0.562 1.235(0.918~1.662) 0.161
年龄
≤68岁 1.00(参照量) 1.00(参照量)
>68岁 2.183(1.278~3.730) 0.004 1.683(1.214~2.334) 0.001
种族
其他 1.00(参照量) 1.00(参照量)
黑人 0.539(0.116~2.490) 0.429 0.720(0.255~2.032) 0.536
白人 0.671(0.234~1.915) 0.456 0.966(0.444~2.104) 0.931
诊断时间段
2010—2015年 1.00(参照量) 1.00(参照量)
2016—2020年 0.718(0.407~1.268) 0.254 0.489(0.341~0.703) <0.001
肿瘤位置
左肺下叶 1.00(参照量) 1.00(参照量)
左肺上叶 0.706(0.337~1.480) 0.357 0.519(0.302~0.892) 0.017
右肺下叶 0.908(0.687~2.064) 0.533 0.827(0.529~1.292) 0.404
右肺中叶 0.768(0.472~1.745) 0.772 0.678(0.292~1.573) 0.366
右肺上叶 0.692(0.384~1.247) 0.221 0.938(0.660~1.331) 0.720
肿瘤大小
1~10 mm 1.00(参照量) 1.00(参照量)
11~20 mm 1.958(0.463~8.270) 0.360 1.547(0.665~3.598) 0.310
21~30 mm 2.080(0.490~8.833) 0.320 1.948(0.839~4.522) 0.120
病理类型
其他 1.00(参照量) 1.00(参照量)
腺癌 0.783(0.325~1.890) 0.587 0.981(0.533~1.803) 0.951
鳞癌 0.905(0.344~2.377) 0.839 0.966(0.498~1.874) 0.919
淋巴结清扫数目
1~3枚 1.00(参照量) 1.00(参照量)
≥4枚 0.999(0.585~1.707) 0.999 1.008(0.721~1.409) 0.960
手术方式
肺叶切除 1.00(参照量) 1.00(参照量)
亚肺叶切除 1.185(0.745~1.885) 0.472 1.171(0.869~1.577) 0.299
), ArticleFig(id=1245407876211131112, tenantId=1146029695717560320, journalId=1146123166801305609, articleId=1245407865092031167, language=CN, label=表3, caption=

倾向性匹配后肿瘤特异性生存和总生存的多因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
项目 肿瘤特异性生存 总生存
风险比(95%可信区间) P 风险比(95%CI可信区间) P
性别
女性 1.00(参照量) 1.00(参照量)
男性 1.147(0.720~1.826) 0.562 1.235(0.918~1.662) 0.161
年龄
≤68岁 1.00(参照量) 1.00(参照量)
>68岁 2.183(1.278~3.730) 0.004 1.683(1.214~2.334) 0.001
种族
其他 1.00(参照量) 1.00(参照量)
黑人 0.539(0.116~2.490) 0.429 0.720(0.255~2.032) 0.536
白人 0.671(0.234~1.915) 0.456 0.966(0.444~2.104) 0.931
诊断时间段
2010—2015年 1.00(参照量) 1.00(参照量)
2016—2020年 0.718(0.407~1.268) 0.254 0.489(0.341~0.703) <0.001
肿瘤位置
左肺下叶 1.00(参照量) 1.00(参照量)
左肺上叶 0.706(0.337~1.480) 0.357 0.519(0.302~0.892) 0.017
右肺下叶 0.908(0.687~2.064) 0.533 0.827(0.529~1.292) 0.404
右肺中叶 0.768(0.472~1.745) 0.772 0.678(0.292~1.573) 0.366
右肺上叶 0.692(0.384~1.247) 0.221 0.938(0.660~1.331) 0.720
肿瘤大小
1~10 mm 1.00(参照量) 1.00(参照量)
11~20 mm 1.958(0.463~8.270) 0.360 1.547(0.665~3.598) 0.310
21~30 mm 2.080(0.490~8.833) 0.320 1.948(0.839~4.522) 0.120
病理类型
其他 1.00(参照量) 1.00(参照量)
腺癌 0.783(0.325~1.890) 0.587 0.981(0.533~1.803) 0.951
鳞癌 0.905(0.344~2.377) 0.839 0.966(0.498~1.874) 0.919
淋巴结清扫数目
1~3枚 1.00(参照量) 1.00(参照量)
≥4枚 0.999(0.585~1.707) 0.999 1.008(0.721~1.409) 0.960
手术方式
肺叶切除 1.00(参照量) 1.00(参照量)
亚肺叶切除 1.185(0.745~1.885) 0.472 1.171(0.869~1.577) 0.299
), ArticleFig(id=1245407876341154547, tenantId=1146029695717560320, journalId=1146123166801305609, articleId=1245407865092031167, language=EN, label=Table 4, caption=

Multivariate analysis using the competing risk model after propensity score matching

, figureFileSmall=null, figureFileBig=null, tableContent=
项目 风险比值(95%可信区间) P
性别
女性 1.00(参照量)
男性 1.090(0.678~1.751) 0.720
年龄
≤68岁 1.00(参照量)
>68岁 2.026(1.166 ~3.521) 0.012
种族
其他 1.00(参照量)
白人 0.930(0.398~2.171) 0.740
诊断时间段
2010—2015年 1.00(参照量)
2016—2020年 0.701(0.406~1.211) 0.200
肿瘤位置
左肺上叶 1.00(参照量)
左肺下叶 0.819(0.387~1.732) 0.600
右肺上叶 0.676(0.376~1.216) 0.190
右肺中叶 0.844(0.322~2.212) 0.730
右肺下叶 1.009(0.517~1.967) 0.980
肿瘤大小
1~10 mm 1.00(参照量)
11~20 mm 1.791(0.478~6.709) 0.390
21~30 mm 1.824(0.474~7.019) 0.380
病理类型
其他 1.00(参照量)
腺癌 0.746(0.301~1.848) 0.530
鳞癌 0.864(0.324~2.302) 0.770
淋巴结清扫数目
1~3枚 1.00(参照量)
≥4枚 1.045(0.609~1.794) 0.870
手术方式
肺叶切除 1.00(参照量)
亚肺叶切除 1.117(0.699~1.786) 0.640
), ArticleFig(id=1245407876454400764, tenantId=1146029695717560320, journalId=1146123166801305609, articleId=1245407865092031167, language=CN, label=表4, caption=

倾向性评分匹配后竞争风险模型多因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
项目 风险比值(95%可信区间) P
性别
女性 1.00(参照量)
男性 1.090(0.678~1.751) 0.720
年龄
≤68岁 1.00(参照量)
>68岁 2.026(1.166 ~3.521) 0.012
种族
其他 1.00(参照量)
白人 0.930(0.398~2.171) 0.740
诊断时间段
2010—2015年 1.00(参照量)
2016—2020年 0.701(0.406~1.211) 0.200
肿瘤位置
左肺上叶 1.00(参照量)
左肺下叶 0.819(0.387~1.732) 0.600
右肺上叶 0.676(0.376~1.216) 0.190
右肺中叶 0.844(0.322~2.212) 0.730
右肺下叶 1.009(0.517~1.967) 0.980
肿瘤大小
1~10 mm 1.00(参照量)
11~20 mm 1.791(0.478~6.709) 0.390
21~30 mm 1.824(0.474~7.019) 0.380
病理类型
其他 1.00(参照量)
腺癌 0.746(0.301~1.848) 0.530
鳞癌 0.864(0.324~2.302) 0.770
淋巴结清扫数目
1~3枚 1.00(参照量)
≥4枚 1.045(0.609~1.794) 0.870
手术方式
肺叶切除 1.00(参照量)
亚肺叶切除 1.117(0.699~1.786) 0.640
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亚肺叶切除与肺叶切除在T≤3 cm N0M0合并胸膜侵犯的早期非小细胞肺癌患者中的远期生存比较
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付浩 , 杨永波 , 梁震 , 熊宏超 *
科学技术与工程 | 论文·医药、卫生 2025,25(7): 2732-2740
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科学技术与工程 | 论文·医药、卫生 2025, 25(7): 2732-2740
亚肺叶切除与肺叶切除在T≤3 cm N0M0合并胸膜侵犯的早期非小细胞肺癌患者中的远期生存比较
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付浩 , 杨永波, 梁震, 熊宏超*
作者信息
  • 北京大学肿瘤医院胸部肿瘤外一科, 北京 100142

    • 付浩(1985—),男,汉族,湖北汉川人,博士。研究方向:胸部肿瘤学。E-mail:。

通讯作者:

* 熊宏超(1972—),男,汉族,北京人,博士。研究方向:胸部肿瘤学。E-mail:。
Long-term Survival Comparison of Sublobar Resection Versus Lobectomy in Early-stage Non-small Cell Lung Cancer Patients(T≤3 cm N0M0) with Visceral Pleural Invasion
Hao FU , Yong-bo YANG, Zhen LIANG, Hong-chao XIONG*
Affiliations
  • Department of Thoracic Surgery, Peking University Cancer Hospital, Beijing 100142, China
出版时间: 2025-03-08 doi: 10.12404/j.issn.1671-1815.2500464
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摘要
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目前研究表明对于分期为T1N0M0的早期非小细胞肺癌,亚肺叶切除的远期疗效不亚于肺叶切除术。但这部分早期肺癌患者仍有可能发生胸膜侵犯,胸膜侵犯与不良预后相关。为此,需对比分析亚肺叶切除和肺叶切除对T≤3 cm N0M0合并胸膜侵犯的非小细胞肺癌患者的远期疗效。现基于SEER(Surveillance, Epidemiology, and End Results)数据库,将2010—2020年肿瘤分期为T≤3 cm N0M0伴有胸膜侵犯的非小细胞肺癌患者分为亚肺叶切除组和肺叶切除组,比较两组患者的肿瘤特异性生存(cancer specific survival, CSS)和总生存(overall survival, OS)。倾向性评分匹配后的单因素分析显示,亚肺叶切除与肺叶切除的CSS和OS均无显著差异。多因素分析亦显示,手术方式并非T≤3 cm N0M0合并胸膜侵犯的非小细胞肺癌患者CSS(HR=1.185, 95%CI: 0.745~1.885, P=0.472)和OS(HR=1.171, 95%CI: 0.869~1.577, P=0.299)的独立的预后因素。亚组分析显示,在各亚组中,两组的CSS和OS均无显著差异。竞争风险模型多因素亦显示,亚肺叶切除与肺叶切除的肺癌特异性死亡率无显著差异。对于分期为T≤3 cm N0M0合并胸膜侵犯的非小细胞肺癌患者,亚肺叶切除的远期生存与肺叶切除相当,可作为该患者群体的手术方式选择。

非小细胞肺癌  /  亚肺叶切除  /  肺叶切除  /  远期生存

Recent studies indicate that for early-stage non-small cell lung cancer(NSCLC) classified as T1N0M0, sublobar resection offers long-term outcomes comparable to lobectomy. However, these early-stage patients may still experience pleural invasion, which is associated with poor prognosis. It is necessary to compare the long-term efficacy of sublobar resection versus lobectomy in patients with T≤3 cm N0M0 NSCLC accompanied by pleural invasion. Research data were sourced from the SEER(Surveillance, Epidemiology, and End Results) database. Patients diagnosed were from between 2010 and 2020 with T≤3 cm N0M0 NSCLC and pleural invasion. Patients were divided into sublobar resection and lobectomy groups, and their cancer-specific survival(CSS) and overall survival(OS) were compared. Univariate analysis post-matching reveale no significant differences in CSS and OS between the sublobar resection and lobectomy groups. Multivariate analysis also indicate that the surgical approach is not an independent prognostic factor for CSS(HR=1.185, 95% CI: 0.745~1.885, P=0.472) and OS (HR=1.171, 95% CI: 0.869~1.577, P=0.299)in patients with T≤3 cm N0M0 NSCLC and pleural invasion. Subgroup analyses show no significant differences in CSS and OS between the two groups across various subgroups. Competing risk model multivariate analysis also demonstrate no significant difference in lung cancer-specific mortality between sublobar resection and lobectomy. In conclusion, for patients with T≤3 cm N0M0 NSCLC accompanied by pleural invasion, sublobar resection offers long-term survival outcomes comparable to lobectomy and can be considered a viable surgical option for this patient population.

non-small cell lung cancer  /  sublobar resection  /  lobectomy  /  long-term survival
付浩, 杨永波, 梁震, 熊宏超. 亚肺叶切除与肺叶切除在T≤3 cm N0M0合并胸膜侵犯的早期非小细胞肺癌患者中的远期生存比较. 科学技术与工程, 2025 , 25 (7) : 2732 -2740 . DOI: 10.12404/j.issn.1671-1815.2500464
Hao FU, Yong-bo YANG, Zhen LIANG, Hong-chao XIONG. Long-term Survival Comparison of Sublobar Resection Versus Lobectomy in Early-stage Non-small Cell Lung Cancer Patients(T≤3 cm N0M0) with Visceral Pleural Invasion[J]. Science Technology and Engineering, 2025 , 25 (7) : 2732 -2740 . DOI: 10.12404/j.issn.1671-1815.2500464
正文
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非小细胞肺癌(non-small cell lung cancer, NSCLC)是全球最常见的恶性肿瘤之一,随着早期筛查技术的发展,临床上越来越多的早期NSCLC得以早期发现和诊断。在这些早期病例中,16%~20%的患者在术后发现具有胸膜侵犯(visceral pleural invasion, VPI),这是一个重要的预后不良因素[1-3]。根据最新的TNM(tumor node metastasis)分期系统,即使是肿瘤直径≤2 cm的NSCLC患者,一旦存在VPI,肿瘤的分期会升级为T2a,从而可能导致更差的疾病无复发生存和总生存率[1,4]。
在外科治疗中,肺叶切除术被认为是早期NSCLC的标准手术方式,特别是在伴随高危因素如VPI的情况下。肺叶切除术因其完整的解剖切除和淋巴结清扫,通常被认为可获得更好的局部控制和生存优势[5]。然而,亚肺叶切除术(包括肺段切除和楔形切除)近年来也逐渐受到关注,特别是对于T1a-bN0M0的患者而言[6]。亚肺叶切除术通过保留更大比例的正常肺组织,可能降低术后并发症并提高生活质量,特别是对存在心肺功能受限的患者具有潜在优势[7-8]。尽管多项临床试验显示亚肺叶切除在无胸膜侵犯的T1a-b NSCLC患者中具有与肺叶切除相当的肿瘤控制效果,但在合并VPI的患者群体中,亚肺叶切除的效果仍存在争议[9]。研究显示[4-5],对于合并VPI的患者,亚肺叶切除可能无法达到与肺叶切除相同的长期生存率和低复发率。此外,胸膜侵犯被认为可能增加肿瘤细胞通过淋巴通路向纵隔淋巴结转移的风险,从而增加复发率和转移风险[4]。
为此,现比较亚肺叶切除与肺叶切除在T≤3 cm N0M0合并VPI的早期NSCLC患者中的远期生存差异,以期为此类患者的外科治疗选择提供更强的证据支持。
1 资料与方法
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1.1 研究对象
选取SEER(Surveillance, Epidemiology, and End Results)数据中的“Incidence-SEER Research Data.17Registries. Nov 2022 Sub”。因数据库自2010年开始记录肺癌的胸膜侵犯信息,故选取2010—2020年伴有胸膜侵犯的原发肺癌数据,共计15 875例患者。第7版TNM分期和第8版TNM分期系统对胸膜侵犯描述相同,故统一采用第8版TNM分期系统。
纳入标准:①病理诊断为非小细胞肺癌;②TNM分期为T2aN0M0,Ib期;③肿瘤小于等于30 mm。
排除标准:①多原发癌;②术前新辅助治疗;③未进行淋巴结清扫或者采样;④原发于气管的肿瘤,跨肺叶肿瘤和部位不明肿瘤;⑤非手术治疗、全肺切除或手术方式不明确。收集患者年龄、性别、种族、治疗时间段、病理类型、肿瘤部位、肿瘤大小、手术方式、术后化疗信息和术后放疗信息。
1.2 伦理申明
使用SEER数据库时,通常不需要进行伦理审查或伦理申明,因为该数据库包含的是匿名的公共健康数据,研究者不直接接触个人身份信息。此外,相关研究通常为观察性,不涉及对参与者的干预或影响,符合伦理规范。
1.3 研究终点
将患者按手术方式分为亚肺叶切除组(包括楔形切除和肺段切除)和肺叶切除术,比较两组的远期生存。主要研究终点为肿瘤特异性生存,定义为手术至因肺癌死亡的生存时间,次要研究终点为总生,定义为手术至因任何原因死亡的生存时间。
1.4 统计方法
统计软件使用R软件(R4.4.1版本)。分类变量比较使用卡方检验或Fisher精确检验,连续变量采用t检验。生存分析采用Kaplan-Meier曲线,差异比较采用Log-rank检验。多因素分析采用COX风险比例模型。因本文研究为回顾性数据分析,为减少偏倚,将亚肺叶切除组和肺叶切除组按1∶1进行倾向性评分匹配(propensity score matching,PSM),匹配变量包括年龄、性别、种族、治疗时间段、病理类型、肿瘤部位、肿瘤大小、手术方式、术后化疗信息和术后放疗。倾向性评分采用Logistic回归模型,使用nearest neighbor methods,卡钳值0.02。P<0.05定义为具有统计学差异。
2 结果分析
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2.1 基本临床特征
按照纳入和排除标准,最终纳入1 918例伴胸膜侵犯的非小细胞肺癌患者(图1)。中位年龄68岁(IQR:62~74岁)。男性802例(41.8%),女性1 116例(58.2%)。病理类型以腺癌为主,为1 547例(80.7%),其次为鳞癌293例(15.3%),腺鳞癌和其他病理类型为78例(4%)。肿瘤大小小于10 mm者92例(4.6%),肿瘤大小11~20 mm者1 005例(45.9%),21~30 mm者1 102例(49.3%)。肺叶切除者1 526例(79.6%),亚肺叶切除者392例(20.4%),包括楔形切除者254例和肺段切除者138例。亚肺叶切除和肺叶切除基本资料对比如表1所示。两组在几项重要临床资料上不平衡,如亚肺叶切除组患者年龄高于肺叶切除组,亚肺叶切除组肿瘤大小较肺叶组小,亚肺叶切除组淋巴结切除数目更少等。
2.2 倾向匹配前生存分析
全组患者1、3、5年CSS分别为97.4%、92.8%和86.7%,1、3、5年OS分别为93.9%、79.8%和67.2%。CSS单因素分析显示,亚肺叶切除组生存差于肺叶切除组,5年CSS分别为79.6%和88.3%,HR=1.776,95%CI:1.260~2.504,P=0.001。CSS多因素分析显示,男性(HR=1.390,95%CI:1.018~1.898,P=0.038)和年龄高(HR=2.406,95%CI:1.708~3.388,P<0.001)是伴有胸膜侵犯的非小细胞肺癌患者的不良预后因素(表2)。而手术方式并非独立预后因素(HR=1.405,95%CI:0.969~2.037,P=0.072)。OS单因素分析显示,亚肺叶切除组生存差于肺叶切除组,5年OS分别为53.9%和70.2%,HR=1.567,95%CI:1.264~1.942,P<0.001。多因素分析显示,亚肺叶切除与总生存的不良预后相关(HR=1.352,95%CI:1.072~1.705,P=0.011),此外,性别,年龄,治疗时间段,肿瘤大小和病理类型也是重要的预后因素(表2)。
2.3 倾向性评分匹配后生存分析
亚肺叶切除组和肺叶切除组在年龄、肿瘤大小和淋巴结清扫数目等临床信息上不平衡,而且这些临床信息通常是重要的预后因素,为减小统计,对两组的临床基本资料进行倾向性评分匹配。匹配后亚肺叶切除组和肺叶切除组均为341例患者,两组临床基本资料平衡(表3)。单因素分析显示,亚肺叶切除组CSS与肺叶切除组无明显差异,5年生存率分别为80.2%和84.5%,HR=1.189,95%CI:0.756~1.867,P=0.452(图2)。在OS分析上,亚肺叶切除组总生存差于肺叶切除组,5年生存率分别为54.5%和66.2%,HR=1.222,95%CI:0.915~1.632,P=0.173。多因素分析显示,手术方式非CSS的独立预后因素,亚肺叶切除与肺叶切除相比无显著生存差异,HR=1.185,95%CI:0.745~1.885,P=0.472。仅高龄(HR=2.183,95%CI:1.278~3.370,P=0.004)与不良预后相关(表3)。OS多因素分析也显示亚肺叶切除与肺叶切除之间无显著生存差异,HR=1.171,95%CI:0.869~1.577,P=0.299。年龄(HR=1.683,95%CI:1.214~2.334,P = 0.001)和治疗时间段(HR=0.489,95%CI:0.341~0.703,P<0.001)是OS独立预后因素。
2.4 亚组分析
亚组分析显示,无论是CSS还是OS,在年龄、种族、治疗时间段、肿瘤部位、肿瘤大小、病理类型、淋巴结清扫数目等亚组中,亚肺叶切除与肺叶切除之间的生存均无明显差异(图3、图4)。仅在女性患者中,亚肺叶切除组患者的生存劣于肺叶切除组,CSS:HR=2.041,95%CI:1.075~3.875,P=0.029;OS:HR=1.868,95%CI:1.232~2.832,P=0.003。
2.5 竞争风险分析
匹配后的患者中,肺癌特异性死亡76例(亚肺叶切除组39例,肺叶切除组37例),其他原因死亡109例(亚肺叶切除组58例,肺叶切除组51例)。竞争风险分析显示,亚肺叶切除组与肺叶切除组相比,患者的肺癌特异性死亡率(两组5年肺癌特性死亡率分别为16.5%和13.8%)和其他原因死亡率(5年其他原因死亡率分别为28.9%和19.8%)均无明显差异(图5)。竞争风险模型多因素亦显示,亚肺叶切除与肺叶切除的肺癌特异性死亡率无显著差异,HR=1.117,95%CI:0.699~1.786,P=0.640(表4)。
3 讨论
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本文研究探讨了在伴有胸膜侵犯的早期非小细胞肺癌患者中亚肺叶切除与肺叶切除的生存差异。对整体患者进行分析显示亚肺叶切除组患者生存劣于肺叶切除组,但这种差异可能与两组患者临床特征不平衡有关,如年龄、肿瘤大小和淋巴结切除数目等重要因素,这些因素可能对生存结果产生了影响,导致统计学偏倚。对比本文研究进行了PSM分析,通过消除这些临床因素的不平衡,重新评估了两组患者的生存结局。多因素分析显示,两组患者在CSS和OS上,亚肺叶切除与肺叶切除具有相当的疗效。
此外,本文研究进一步进行了亚组分析,在不同亚组中两者的生存亦无显著差异。因早期肺癌患者预后相对较好,存在其他原因死亡的竞争风险,就竞争风险模型的单因素和多因素分析,均显示亚肺叶切除与肺叶切除患者肺癌特异性死亡率无显著差异。
本文研究结果与既往两项SEER数据库分析结果有所不同。Song等[10]研究分析了2010—2015年SEER数据中2 230例患者,也进行了PSM分析,结果显示对于伴有胸膜侵犯的NSCLC患者,行肺叶切除患者生存显著优于亚肺叶切除者。但该研究并非仅纳入早期肺癌患者,研究中包括了T分期为T2~T4的患者,和淋巴结转移甚至远处转移的患者,这可能严重影响生存分析结果。另外一项是Yu等[11]的研究,分析了2004—2013年SEER数据库的1 386例伴有胸膜侵犯的早期NSCLC(T≤2 cm N0M0)患者,并且进行了PSM和IPTW双重分析,结果均显示肺叶切除患者生存优于亚肺叶切除患者。该研究虽然对TNM分期进行了严格限制,但该研究未区分患者是否接受了新辅助化疗,因为2004—2009年的SEER数据库尚未对此进行区分,这可能导致纳入的患者为局部进展期降期的患者,会影响分析结果。而本文研究排除了新辅助化疗和放疗的患者,且纳入的均为进行淋巴结切除的患者, 这使得患者TNM分期更为准确。
一项来自NCDB数据库的研究支持本研究结果[5]。研究分析了2010—2020年NCDB数据的2 568例伴有胸膜侵犯的早期NSCLC(T1a-bN0M0)患者,进行PSM后,结果显示肺段切除与肺叶切除生存无显著差异。NCDB数据库提供的临床信息更为详细,故认为筛选患者也更为严格。
JCOG0802研究[12]和CALGB149503研究[13]显示,亚肺叶切除与肺叶切除在T≤2 cm的NSCLC患者中具有相当的疗效。但对于T1c(2 cm<T≤3 cm)的早期NSCLC,亚肺叶切除与肺叶切除的远期疗效尚不明确。有些回顾性研究显示,对于这部分患者,亚肺叶切除亦能达到与肺叶切除相当的疗效。例如,Hattori等[14]的研究显示,对于T1c的实行成分为主的IA期NSCLC,肺段切除能达到与肺叶切除相当的疗效,两组总生存和局部复发率无差异。Chan等[15]的研究显示,在cT1cN0M0的NSCLC患者中,肺段切除组患者的年龄更高,但与肺叶切除相比,两组的总生存和无复发生存亦无显著差异。本研究纳入了2 cm<T≤3 cm的患者,因为伴有胸膜侵犯患者的病灶位于肺外周,通常行亚肺叶切除能到充足的切缘。本文研究亚组分析显示,对于这部分患者,亚肺叶切除与肺叶切除相比,在CSS和OS均无显著差异。
尽管亚肺叶切除与肺叶切除在本研究中表现出相似的生存结局,仍然需要考虑患者的个体化情况来选择最合适的手术方式。例如,对于年轻且肺功能较好的患者,肺叶切除可能仍是最佳选择,因为其能够提供更彻底的肿瘤切除和更低的复发率。然而,对于老年患者、慢性肺病患者或高风险患者,亚肺叶切除可能因其较低的术后并发症和更好的术后恢复而成为一个合适的选择[10]。但本研究的亚组分析显示,对于大于68岁或小于68岁的患者,亚肺叶切除与肺叶切除的CSS和OS均相似。提示在年轻患者中亦可以考虑亚肺叶切除,以保留更多肺功能。
本文研究仍存在一定的局限性。作为一项回顾性研究,虽然使用了SEER数据库的大量数据,但回顾性设计可能引入选择偏倚和信息偏倚,且无法完全控制所有潜在的混杂因素。其次,数据库无法提供一些重要的临床信息,如肺功能、心肺基础疾病等,这些因素可能影响手术方式的选择,从而影响研究结果的准确性。虽然通过倾向性评分匹配(PSM)进行了调整,但手术方式的选择仍可能受到患者临床特征的影响。此外,术后随访时间的差异可能影响生存结局的评估,尤其是在随访较短的患者中,可能未能充分反映长期生存的差异。
4 结论
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本文研究基于SEER数据库的大样本数据,探讨了亚肺叶切除与肺叶切除在T≤3 cm N0M0合并胸膜侵犯的NSCLC患者中的远期疗效差异。通过倾向性评分匹配平衡基线特征后,结果显示,亚肺叶切除与肺叶切除的远期生存相似。因此,对于T≤3 cm N0M0合并胸膜转移的NSCLC患者,亚肺叶切除可作为肺叶切除的一种替代方案,尤其适用于心肺功能受限或需保留肺实质的患者。
基金
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  • 国家重点研发计划(2021YFC2500900)
文献
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参考文献 引证文献
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2025年第25卷第7期
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文章信息
doi: 10.12404/j.issn.1671-1815.2500464
  • 接收时间：2025-01-18
  • 首发时间：2026-03-30
  • 出版时间：2025-03-08
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  • 收稿日期：2025-01-18
  • 修回日期：2025-02-26
基金
国家重点研发计划(2021YFC2500900)
作者信息
    北京大学肿瘤医院胸部肿瘤外一科, 北京 100142

通讯作者:

* 熊宏超(1972—),男,汉族,北京人,博士。研究方向:胸部肿瘤学。E-mail:。
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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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