Background/Objectives: While sublobar resection (SLR) is accepted for selected small, early non-small-cell lung cancers (NSCLCs), its efficacy for tumors with visceral pleural invasion (VPI) remains debated. This study aimed to compare lung-cancer-specific survival (LCSS) between SLR and lobectomy in pT2a (tumor ≤ 3 cm with VPI) N0M0 NSCLCs from a nationwide population-based database.Methods: This retrospective study utilized Taiwan Cancer Registry data from 2011 to 2018, selecting patients with pT2a (tumor ≤ 3 cm with VPI) N0M0 NSCLC that underwent SLR or lobectomy, with specific exclusion criteria. Propensity score matching (1:1) was performed using a greedy algorithm with a 0.01 caliper width. LCSS was compared using Kaplan–Meier analysis with log-rank tests and Cox proportional hazards models before and after matching.Results: In the 2460-patient cohort (624 SLR, 1836 lobectomy) before matching, lobectomy was associated with significantly better overall (p= 0.01) and PL1 VPI subgroup (p= 0.009) LCSS. In the matched cohort (523 pairs), no significant difference in LCSS was observed between SLR and lobectomy, either overall (p= 0.21) or when stratified by PL1 (p= 0.11) or PL2 (p= 0.94) status. Multivariate Cox analysis in the matched cohort confirmed no significant association between surgery type and LCSS (adjusted HR 0.75, 95% CI 0.52–1.08,p= 0.124), but older age (>75 years), PL2 VPI, and lymphovascular invasion were independent predictors of worse LCSS (allp< 0.001).Conclusions: This large population-based study, after rigorous adjustment for confounders, found that SLR and lobectomy provided comparable LCSS. SLR may be an alternative for selected patients, but prospective validation is recommended.
背景/目的：尽管亚肺叶切除术（SLR）已被认可用于部分早期小体积非小细胞肺癌（NSCLC）的治疗，但其对伴有脏层胸膜侵犯（VPI）肿瘤的疗效仍存争议。本研究旨在基于全国性人群数据库，比较pT2a期（肿瘤≤3 cm伴VPI）N0M0 NSCLC患者接受SLR与肺叶切除术后的肺癌特异性生存率（LCSS）。方法：本回顾性研究利用2011年至2018年台湾癌症登记数据，筛选接受SLR或肺叶切除术的pT2a期（肿瘤≤3 cm伴VPI）N0M0 NSCLC患者，并设定特定排除标准。采用贪婪算法以0.01卡钳宽度进行倾向评分匹配（1:1）。通过Kaplan-Meier分析（对数秩检验）和Cox比例风险模型比较匹配前后的LCSS差异。结果：在匹配前的2460例患者队列中（624例SLR，1836例肺叶切除术），肺叶切除术与显著更优的总体LCSS（p=0.01）及PL1 VPI亚组LCSS（p=0.009）相关。在匹配后的队列（523对）中，SLR与肺叶切除术的LCSS无显著差异，无论是总体比较（p=0.21），还是按PL1（p=0.11）或PL2（p=0.94）状态分层分析。匹配队列的多变量Cox分析证实手术类型与LCSS无显著关联（校正后HR 0.75，95% CI 0.52–1.08，p=0.124），但高龄（>75岁）、PL2级VPI和淋巴血管侵犯是LCSS恶化的独立预测因素（均p<0.001）。结论：这项大规模人群研究经过严格的混杂因素调整后，发现SLR与肺叶切除术的LCSS相当。SLR可作为特定患者的替代术式，但建议进行前瞻性验证。
肿瘤(癌症)患者之家