Background: Lung-sparing procedures, specifically segmentectomies and wedge resections, have increased over the years to treat early-stage non-small cell lung cancer (NSCLC). We investigate here the perioperative and long-term outcomes of patients who underwent robotic-assisted segmentectomy (RAS) at an NCI-designated cancer center and aim to show associations between the preoperative standard update value (SUV) to tumor stage, recurrence patterns, and overall survival. Methods: A retrospective analysis was performed on 166 consecutive patients who underwent RAS at a single institution from 2010 to 2021. Of this number, 121 robotic-assisted segmentectomies were performed for primary NSCLC, and a total of 101 patients were evaluated with a PET-CT scan. The SUV from the primary tumor was determined from the PET-CT. The clinical, surgical, and pathologic profiles and perioperative outcomes were summarized via descriptive statistics. Numerical variables were described as the median and interquartile range because all numerical variables were not normally distributed as assessed by the Shapiro–Wilk test of normality. Categorical variables were described as the count and proportion. Chi-square or Fisher’s exact test was used for association. The main outcomes were overall survival (OS) and recurrence-free survival (RFS). Kaplan–Meier (KM) curves were constructed to visualize the OS and RFS, which were also stratified according to tumor histology, the pathologic stage, and standard uptake value. A log-rank test for the equality of survival curves was performed to determine significant differences between groups. Results: The most common postoperative complications were atrial fibrillation (8.8%, 9/102), persistent air leak (7.84%, 8/102), and pneumonia (4.9%, 5/102). The median operative duration was 168.5 min (IQR 59), while the median estimated blood loss was 50 mL (IQR 125). The conversion rate to thoracotomy in this cohort was 3.9% (4/102). Intraoperative complications occurred in 2.9% (3/102). The median hospital length of stay was 3 days (IQR 3). The median chest tube duration was 3 days (IQR 2), but 4.9% (5/102) of patients were sent home with a chest tube. The recurrence for this cohort was 28.4% (29/102). The time to recurrence was 353 days (IQR 504), while the time to mortality was 505 days (IQR 761). The NSCLC patients were divided into the following two groups: low SUV (<5,n= 55) and high SUV (≥5,n= 47). Statistically significant associations were noted between SUV and the tumor histology (p =0.019), tumor grade (p =0.002), lymph-vascular invasion (p =0.029), viscera-pleural invasion (p =0.008), recurrence (p< 0.001) and the site of recurrence (p =0.047). KM survival analysis showed significant differences in the curves for OS (log-rankp-value 0.0204) and RFS (log-rankp-value 0.0034) between the SUV groups. Conclusion: Robotic-assisted segmentectomy for NSCLC has reasonable perioperative and oncologic outcomes. Furthermore, we demonstrate here the prognostic implication of preoperative SUV to pathologic outcomes, recurrence-free survival, and overall survival.
背景：近年来，为治疗早期非小细胞肺癌（NSCLC），保留肺实质的手术（特别是肺段切除术和楔形切除术）的应用日益增多。本研究旨在探讨在一家美国国家癌症研究所（NCI）指定的癌症中心接受机器人辅助肺段切除术（RAS）患者的围手术期及长期预后，并分析术前标准摄取值（SUV）与肿瘤分期、复发模式及总生存期之间的关联。方法：对2010年至2021年间在同一机构连续接受RAS的166例患者进行回顾性分析。其中，121例机器人辅助肺段切除术用于治疗原发性NSCLC，共有101例患者接受了PET-CT检查评估。通过PET-CT测定原发肿瘤的SUV值。采用描述性统计方法总结临床、手术、病理特征及围手术期结局。由于经Shapiro-Wilk正态性检验，所有数值变量均不符合正态分布，故以中位数和四分位距进行描述；分类变量以计数和比例表示。采用卡方检验或Fisher精确检验进行关联性分析。主要结局指标为总生存期（OS）和无复发生存期（RFS）。通过绘制Kaplan-Meier（KM）曲线直观展示OS和RFS，并依据肿瘤组织学类型、病理分期及标准摄取值进行分层。采用对数秩检验比较生存曲线的差异，以确定组间是否存在显著性差异。结果：最常见的术后并发症为心房颤动（8.8%，9/102）、持续性漏气（7.84%，8/102）和肺炎（4.9%，5/102）。中位手术时间为168.5分钟（IQR 59），中位估计失血量为50毫升（IQR 125）。该队列中转开胸手术的比例为3.9%（4/102）。术中并发症发生率为2.9%（3/102）。中位住院时间为3天（IQR 3）。中位胸腔引流管留置时间为3天（IQR 2），但有4.9%（5/102）的患者带管出院。该队列的复发率为28.4%（29/102）。中位复发时间为353天（IQR 504），中位死亡时间为505天（IQR 761）。将NSCLC患者分为以下两组：低SUV组（<5，n=55）和高SUV组（≥5，n=47）。统计分析显示，SUV与肿瘤组织学类型（p=0.019）、肿瘤分级（p=0.002）、淋巴血管侵犯（p=0.029）、脏层胸膜侵犯（p=0.008）、复发（p<0.001）及复发部位（p=0.047）之间存在显著关联。KM生存分析显示，不同SUV组间的OS曲线（对数秩检验p值0.0204）和RFS曲线（对数秩检验p值0.0034）存在显著差异。结论：机器人辅助肺段切除术治疗NSCLC具有合理的围手术期和肿瘤学结局。此外，本研究揭示了术前SUV对病理结局、无复发生存期和总生存期的预后意义。
肿瘤(癌症)患者之家