目前,关于一期肺类癌(PC)肿瘤的手术范围尚无共识,其中包括典型类癌(TC)和非典型类癌(AC)肿瘤。亚叶切除包括节段性切除和楔形切除;前者被认为是一种更适合肿瘤治疗的解剖切除类型。因此,两种手术方式对患者生存时间的影响是否存在差异,有待进一步验证。使用倾向评分匹配(PSM)。主要终点是癌症特异性生存期(CSS)和总生存期(OS)时间。通过Kaplan-Meier方法和对数秩检验分析生存差异。在TC或AC肿瘤组中,PSM后肺叶下切除术和肺叶切除术组之间的生存率均无明显差异(均p>0.05)。共有1680例患者接受了肺楔形切除术(TC:n=1547,AC:n=133),398例患者接受了节段性切除术(TC:n=365,AC:n=33)。PSM之后,生存率没有统计学上的显著差异,无论OS或CSS是否被认为是主要终点(OS:p=0.337;CSS:p=0.470)。此外,在组织学基础上的不同亚组分析中,与楔形切除术相比,节段切除术没有延长患者的生存时间,年龄,和肿瘤大小(均p>0.05)。最后,通过多变量Cox分析获得了相同的结果(OS:p=0.153;HR=1.21;CSS:p=0.351,HR=1.32).对于早期典型或非典型的肺类癌患者,可考虑进行肺叶下切除术。前提是进行严格的淋巴结评估。如果肿瘤远离肺门,根据肿瘤的具体位置和患者的临床状况,可以进行段切除术或楔形切除术。
Currently, there is no consensus regarding the extent of surgery for stage I pulmonary carcinoid (PC) tumors, which encompass typical carcinoid (TC) and atypical carcinoid (AC) tumors. Sublobar resection includes segmental resection and wedge resection; the former is regarded as a type of anatomical resection that is better suited for tumor treatment. Therefore, it needs to be further verified whether differences exist in the effects of the two surgical methods on the survival time of patients. Propensity score matching (PSM) was used. The primary endpoints were cancer-specific survival (CSS) and overall survival (OS) time. Survival differences were analyzed via the Kaplan-Meier method and the log-rank test. There was no significant difference in survival between the sublobar resection and lobectomy groups after PSM in either the TC or AC tumor groups (all p > 0.05). A total of 1680 patients underwent pulmonary wedge resection (TC: n = 1547, AC: n = 133), and 398 patients underwent segmental resection (TC: n = 365, AC: n = 33). After PSM, there were no statistically significant differences in survival, regardless of whether OS or CSS was considered the primary endpoint (OS: p = 0.337; CSS: p = 0.470). Furthermore, segmental resection did not prolong patient survival time compared with wedge resection in different subgroup analyses on the basis of histology, age, and tumor size (all p > 0.05). Finally, the same results were obtained via multivariate Cox analysis (OS: p = 0.153; HR = 1.21; CSS: p = 0.351, HR = 1.32). Sublobar resection could be considered for patients with early-stage typical or atypical pulmonary carcinoid, provided that a rigorous lymph node evaluation is conducted. If the tumor is distant from the pulmonary hilum, either segmentectomy or wedge resection may be performed depending on the specific location of the tumor and the clinical condition of the patient.