Background: Sublobar resection (SLR), including segmentectomy and wedge resection (WR), is an alternative to lobectomy for early-stage lung cancer due to its potential benefits in preserving lung function. However, the comparative outcomes between segmentectomy and WR for stage IA lung adenocarcinoma are equivocal. This population-based study aimed to compare overall survival between segmentectomy and WR. Methods: Data on patients with clinical stage IA lung adenocarcinoma were collected from the Taiwan Cancer Registry between 2011 and 2018. The primary endpoint was overall survival. Further subgroup survival analyses were conducted based on tumor size. Propensity score matching (PSM) was used to balance baseline differences such as age and tumor stage between the two groups. Predictors of survival other than the surgical procedure were analyzed using a Cox regression model. Results: In total, 6598 patients with stage IA lung adenocarcinoma undergoing SLR between 2011 and 2018 were enrolled, including 2061 and 4537 receiving segmentectomy and WR, respectively. The mean age was 60.3 ± 11.7 years, 66.2% were female, and 81.5% never smoked. After PSM, segmentectomy was associated with significantly better overall survival than WR (p= 0.019), especially for tumors larger than 2 cm (p< 0.001). Aside from segmentectomy, age ≤ 75 years, well-differentiated tumors, small tumor size, and the absence of nodal metastasis were associated with better overall survival. Conclusions: Segmentectomy offered superior overall survival for patients with tumors larger than 2 cm. For tumors smaller than 2 cm, the outcomes of segmentectomy and WR were comparable, offering flexibility in surgical decision-making. These findings highlight the need for individualized surgical approaches based on tumor characteristics.
背景：对于早期肺癌，肺叶切除术的替代方案包括肺段切除术和楔形切除术在内的亚肺叶切除术，因其在保留肺功能方面具有潜在优势。然而，针对IA期肺腺癌，肺段切除术与楔形切除术的疗效比较尚不明确。本研究基于人群数据，旨在比较肺段切除术与楔形切除术的总生存期差异。 方法：从2011年至2018年台湾癌症登记数据库中收集临床IA期肺腺癌患者数据。主要研究终点为总生存期。根据肿瘤大小进一步进行亚组生存分析。采用倾向性评分匹配法平衡两组间年龄、肿瘤分期等基线差异。除手术方式外，其他生存预测因素通过Cox回归模型进行分析。 结果：2011年至2018年间共纳入6598例接受亚肺叶切除术的IA期肺腺癌患者，其中肺段切除术2061例，楔形切除术4537例。患者平均年龄为60.3±11.7岁，女性占66.2%，81.5%无吸烟史。经倾向性评分匹配后，肺段切除术患者的总生存期显著优于楔形切除术（p=0.019），尤其在肿瘤直径大于2厘米的亚组中差异更为显著（p<0.001）。除肺段切除术外，年龄≤75岁、高分化肿瘤、较小肿瘤体积及无淋巴结转移均与更好的总生存期相关。 结论：对于肿瘤直径大于2厘米的患者，肺段切除术能提供更优的总生存期。对于直径小于2厘米的肿瘤，两种术式疗效相当，为手术决策提供了灵活性。这些发现强调需要根据肿瘤特征制定个体化的手术方案。
Segmentectomy Versus Wedge Resection for Stage IA Lung Adenocarcinoma—A Population-Based Study
肿瘤(癌症)患者之家