Sublobar resection is a standard surgical procedure for small-sized non-small-cell lung cancer (NSCLC). However, the clinical role of adjuvant chemotherapy for small-sized NSCLC with pathological lymph node (LN) metastasis after sublobar resection is unknown. The National Cancer Database was queried for NSCLC patients between 2004 and 2018. Eligibility included sublobar resection with pathological LN metastasis, R0 resection, Charlson comorbidity score = 0, clinical stage T1a-b, and tumor size ≤ 20 mm. The Kaplan–Meier method with a log-rank test and multivariable Cox proportional hazards analyses were used for assessing survival. The samples were evaluated before and after propensity score matching (PSM) with respect to age, sex, histologic type, and pathological LN status. Of 810 patients who met the eligibility criteria, 567 (70.0%) underwent adjuvant chemotherapy. After PSM, patients with adjuvant chemotherapy had a significantly longer survival than those without (median survival: 64.3 vs. 34.0 months, hazard ratio for death: 0.61,p< 0.0001). Multivariate analyses after PSM showed that younger age (p= 0.0206), female (p= 0.0005), and adjuvant chemotherapy (p< 0.0001) were independent prognostic factors for longer survival. Adjuvant chemotherapy has a prognostic impact in patients with small-sized NSCLC and pathological lymph node metastasis who undergo sublobar resection.
亚肺叶切除术是治疗小型非小细胞肺癌的标准外科术式。然而，对于亚肺叶切除术后存在病理性淋巴结转移的小型非小细胞肺癌患者，辅助化疗的临床作用尚不明确。本研究通过美国国家癌症数据库检索2004年至2018年间的非小细胞肺癌患者数据。纳入标准包括：接受亚肺叶切除术且存在病理性淋巴结转移、R0切除、查尔森合并症评分为0、临床分期T1a-b、肿瘤尺寸≤20毫米。采用Kaplan-Meier法（时序检验）及多变量Cox比例风险模型进行生存分析。通过倾向评分匹配对年龄、性别、组织学类型及病理性淋巴结状态进行匹配前后的样本评估。在符合纳入标准的810例患者中，567例（70.0%）接受了辅助化疗。倾向评分匹配后显示，接受辅助化疗的患者生存期显著优于未接受者（中位生存期：64.3个月 vs 34.0个月，死亡风险比：0.61，p<0.0001）。匹配后的多变量分析表明，较年轻年龄（p=0.0206）、女性（p=0.0005）及辅助化疗（p<0.0001）是延长生存期的独立预后因素。对于接受亚肺叶切除术且存在病理性淋巴结转移的小型非小细胞肺癌患者，辅助化疗具有显著的预后改善作用。
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