Objective:Segmentectomy has recently been accepted as a valid anatomical resection in the early stages non-small cell lung cancer, even if different segment numbers and combinations are included. The aim of this study is to analyze prognostic factors in patients who underwent segmentectomy, with particular attention to segment numbers and characteristics.Methods:Characteristics of patients who underwent uniportal VATS segmentectomy from 1/01/2017 to 31/12/2022 were reviewed and retrospectively analyzed. Patients with nodal involvement and/or distant metastases, tumors > 4 cm, who received neoadjuvant treatment and those who underwent completion lobectomy were excluded. Operatory and pathological reports were reviewed to collect data on surgical characteristics and pathology. Segmentectomies were categorized according to numbers of resected segments as single/multiple. Clinico-pathological characteristics, number of segments and nodal parameters were associated to overall survival (OS) using Kaplan–Meier curves. The log-rank test was used to assess differences between subgroups. A multivariable model was built using Cox-regression analysis including variables withp-values < 0.10 at univariable analysis.Results:The final analysis was conducted on 95 patients who met the inclusion criteria. Multiple segmentectomies were performed in 47 (49.4%) cases, of which 37 (39%) were complex cases. At univariable analysis, tumor size ≤ 2 cm (p= 0.006, HR:0.260; 95%CI 0.099–0.686) significantly correlated with OS: patients with pT ≤ 2 cm presented a 5YOS of 85.3% vs. 48.3% of patients with pT >2 cm, with multivariable-confirmed tumor size ≤ 2 cm as an independent prognostic factor (p= 0.004, HR:0.204; 95%CI 0.069–0.607). Considering the tumor size according to number of resected segments, patients who underwent single segmentectomy presented a significantly better survival for pT ≤ 2 cm: 5YOS 91.7% vs. 41.3% for pT > 2 cm (p= 0.001). Conversely, no significant differences in OS were present in multiple segmentectomy: 5YOS 78.9% vs. 77.1% (p= 0.700). Similarly, pT ≤ 2 cm correlated with OS in complex segmentectomy (p= 0.010) but not in simple segmentectomy (p= 0.098).Conclusions:Our study confirms the distinct prognosis associated with tumor dimensions in patients who underwent uniportal VATS segmentectomy. We confirmed the tumor dimension cut-off of 2 cm as a robust prognosticator in single and complex segmentectomies. However, no significant differences in survival were observed in multiple and simple segmentectomies, implying that tumors larger than 2 cm may necessitate extended resections.
目的：近年来，肺段切除术已被认可为早期非小细胞肺癌的有效解剖性切除方式，即使涉及不同肺段数量及组合。本研究旨在分析接受肺段切除术患者的预后因素，重点关注肺段数量及其特征。 方法：回顾性分析2017年1月1日至2022年12月31日期间接受单孔胸腔镜肺段切除术患者的临床资料。排除存在淋巴结转移和/或远处转移、肿瘤直径>4 cm、接受新辅助治疗及中转肺叶切除术的患者。通过查阅手术记录与病理报告收集手术特征及病理学数据。根据切除肺段数量将肺段切除术分为单肺段切除与多肺段切除。采用Kaplan-Meier曲线分析临床病理特征、肺段数量及淋巴结参数与总生存期（OS）的关联性，组间差异通过log-rank检验评估。将单因素分析中p值<0.10的变量纳入Cox回归模型进行多因素分析。 结果：最终纳入符合标准的95例患者进行分析。其中47例（49.4%）实施多肺段切除，含37例（39%）复杂肺段切除。单因素分析显示，肿瘤直径≤2 cm（p=0.006，HR:0.260；95%CI 0.099–0.686）与OS显著相关：pT≤2 cm患者的5年OS为85.3%，而pT>2 cm患者为48.3%。多因素分析证实肿瘤直径≤2 cm是独立预后因素（p=0.004，HR:0.204；95%CI 0.069–0.607）。按切除肺段数量分层分析显示，单肺段切除患者中pT≤2 cm者生存率显著更优：5年OS为91.7% vs. pT>2 cm者的41.3%（p=0.001）；而多肺段切除患者中OS无显著差异：5年OS为78.9% vs. 77.1%（p=0.700）。类似地，复杂肺段切除中pT≤2 cm与OS相关（p=0.010），但简单肺段切除中未见显著关联（p=0.098）。 结论：本研究证实肿瘤大小对接受单孔胸腔镜肺段切除术患者的预后具有显著影响。我们验证了2 cm作为单肺段切除及复杂肺段切除术中可靠的预后界值。然而，在多肺段切除及简单肺段切除术中未观察到生存率的显著差异，提示直径超过2 cm的肿瘤可能需要更广泛的切除范围。
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