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Tytuł pozycji:

Re-Assessment of Intentional Extended Segmentectomy for Clinical T1aN0 Non-Small Cell Lung Cancer.

Tytuł :
Re-Assessment of Intentional Extended Segmentectomy for Clinical T1aN0 Non-Small Cell Lung Cancer.
Autorzy :
Nishio W; Department of Chest Surgery, Hyogo Cancer Center, Akashi, Japan. Electronic address: .
Yoshimura M; Department of Chest Surgery, Hyogo Cancer Center, Akashi, Japan.
Maniwa Y; Department of Surgery, Division of Chest Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Kitamura Y; Department of Chest Surgery, Hyogo Cancer Center, Akashi, Japan.
Tane K; Department of Chest Surgery, Hyogo Cancer Center, Akashi, Japan.
Takenaka D; Department of Radiology, Hyogo Cancer Center, Akashi, Japan.
Adachi S; Department of Radiology, Hyogo Cancer Center, Akashi, Japan.
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Źródło :
The Annals of thoracic surgery [Ann Thorac Surg] 2016 Nov; Vol. 102 (5), pp. 1702-1710. Date of Electronic Publication: 2016 Aug 12.
Typ publikacji :
Journal Article
Język :
English
Imprint Name(s) :
Publication: Amsterdam : Elsevier
Original Publication: Boston.
MeSH Terms :
Neoplasm Staging*
Lung Neoplasms/*surgery
Pneumonectomy/*methods
Risk Assessment/*methods
Tomography, X-Ray Computed/*methods
Aged ; Carcinoma, Non-Small-Cell Lung/diagnosis ; Carcinoma, Non-Small-Cell Lung/mortality ; Carcinoma, Non-Small-Cell Lung/surgery ; Female ; Follow-Up Studies ; Humans ; Japan/epidemiology ; Lung Neoplasms/diagnosis ; Lung Neoplasms/mortality ; Male ; Middle Aged ; Prognosis ; Propensity Score ; Retrospective Studies ; Risk Factors ; Survival Rate/trends
Entry Date(s) :
Date Created: 20160817 Date Completed: 20170330 Latest Revision: 20171224
Update Code :
20201218
DOI :
10.1016/j.athoracsur.2016.05.071
PMID :
27526651
Czasopismo naukowe
Background: This study compares long-term prognosis of intentional extended segmentectomy and lobectomy of clinical T1aN0M0 non-small cell lung cancer (NSCLC). Risk factors of local-regional recurrence are identified and segmentectomy outcomes are examined per segment.
Methods: 164 intentional extended segmentectomies were compared with 73 lobectomies subcategorized by consolidation to maximum tumor diameter ratio (C/T) measured by computed tomographies. Preoperative characteristics were propensity score matched to evaluate local-regional recurrence-free survival using the log-rank test. Preoperative factors and surgical procedure were analyzed with the Cox proportional hazards regression model to identify independent predictor of local-regional recurrence. Local-regional recurrence per segment were assessed by Kaplan-Meier estimates between both groups.
Results: No recurrences were observed for 46 C/T ≤0.5 segmentectomies. In 59 C/T >0.5 propensity score-matched pairs, 5-year local-regional recurrence-free survival rates of segmentectomies were 76.3%, versus 91.5% for lobectomies (p = 0.082). Multivariate analysis confirmed segmentectomies to be the only independent risk factor for local-regional recurrence-free probability (p = 0.020). Subset analysis reveals superior segmentectomies have significantly less local-regional recurrence (p = 0.029) than other segments and comparable prognosis to lower lobectomies. Left upper lobe segmentectomies also showed comparable prognosis to lobectomies. Segmentectomies in the right upper lobe and of basal segments showed significantly higher local recurrence (p = 0.001) than other segments. Basal segmentectomies showed significantly poor prognosis versus lower lobectomies (p = 0.005).
Conclusions: For radiographically invasive right upper lobe or basal segment clinical T1a NSCLC, strict inclusion criteria is necessary for intentional segmentectomy. For superior and left upper lobe segments, however, segmentectomies may be preferred with prognosis comparable to lobectomies.
(Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Comment in: Ann Thorac Surg. 2017 Sep;104(3):1096. (PMID: 28163038)
Comment in: Ann Thorac Surg. 2017 Sep;104(3):1095-1096. (PMID: 28838490)
Comment in: J Thorac Dis. 2017 Oct;9(10 ):3501-3505. (PMID: 29268326)
Comment in: J Thorac Dis. 2017 Nov;9(11):4146-4148. (PMID: 29268455)

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