【摘要】 背景与目的美国国立综合癌症网络(National Comprehensive Cancer Network,NCCN)指南推荐,大部分可手术切除的肺癌首选电视辅助胸腔镜手术(video-assisted thoracoscopic surgery,VATS)解剖性肺叶切除。而研究证实肺段切除I期肺癌对肺功能的保护优于肺叶切除。目前,临床上对I期肺腺癌VATS亚肺叶切除能否获得与肺叶切除同等疗效仍未确定,现分析两种手术方式治疗I期肺腺癌预后的比较。方法回顾性研究2009年1月-2011年12月广州医科大学附属第一医院收治的I期肺腺癌患者,其中VATS肺叶切除222例,亚肺叶切除36例;对两组患者使用倾向评分匹配(propensity score matching,PSM),比较两组患者的临床病理特征及生存预后。结果两组匹配患者35例,匹配后VATS肺叶切除组与亚肺叶切除组的术后无病生存期(disease free survival,DFS)分别为49.3个月、42.7个月,差异无统计学意义(P=0.137);两组术后总生存期(overall survival,OS)分别为50.3个月、49.0个月,差异无统计学意义(P=0.122)。分期分层结果示,Ia期肺叶切除和亚肺叶切除两组术后DFS差异无统计学意义;而Ib期肺叶切除和亚肺叶切除两组术后DFS差异有统计学意义。结论 Ia期肺腺癌VATS亚肺叶切除的生存预后不亚于肺叶切除,Ib期肺腺癌建议选择VATS肺叶切除治疗。更多还原

【Abstract】 Background and objective National Comprehensive Cancer Network(NCCN) guidelines recommend video-assisted thoracoscopic surgery(VATS) anatomical lobectomy as the first choice for the treatment of resectable lung cancer. However, sublobar resection offers significantly better functional preservation compared with lobectomy for stage I lung cancer. At present, the inferiority of sublobar resection to lobectomy is still uncertain. Herein, we compared the prognoses of these two types of surgical treatment for stage I lung adenocarcinoma. Methods Retrospective research was conducted on 258 patients with stage I lung adenocarcinomas who underwent VATS lobectomy and sublobar resection at the First Affiliated Hospital of Guangzhou Medical University between January 2009 and December 2011. VATS lobectomy was performed on 222 patients, and VATS sublobe resection was performed on 36 patients. Propensity score matching analyses were conducted on the two groups. Results A total of 70 patients were matched in the two groups. No significant difference was observed between the lobectomy and sublobar resection groups after matching(P=0.137). The disease-free survival(DFS) of the two groups were 49.3 and 42.7 months, and their overall survival(OS) were 50.3 and 49.0 months(P=0.122). Further, stratified analysis showed no significant differences in DFS and OS between the two groups with stage Ia lung adenocarcinoma. Nevertheless, the DFS and OS of the two groups significantly differed in matched patients with stage Ib lung adenocarcinomas. Conclusion Sublobar resection could achieve a similar prognosis to VATS lobectomy for stage Ia lung adenocarcinoma. Lobectomy should still be the first choice for the treatment of stage Ib lung adenocarcinoma.更多还原