本期胸小星将为大家带来胸腔镜肺段切除术后切缘距离对局部区域复发及生存的影响；青少年中磨玻璃结节为特征的肺腺癌：特征、手术结局和管理策略，一起来看看吧！
2017·EATTS
01
Lin Huang MD, PhD1, René Horsleben Petersen MD, PhD1
1 Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Background:
This study aimed to identify the impact of margin distance on locoregional recurrence (LRR) and survival outcomes following thoracoscopic segmentectomy for non-small cell lung cancer.
Methods:
We retrospectively analyzed data from prospectively collected consecutive thoracoscopic segmentectomies in a single center from January 2008 to February 2023. The restricted cubic spline of the adjusted Cox regression model for LRR displayed the breakpoint of margin distance. The Kaplan-Meier estimator with log-rank test evaluated the overall survival between the two groups stratified by the breakpoint, and the Aalen-Johansen estimator with Gray’s test assessed the LRR-free survival and lung cancer-specific survival in the competing model.
Results:
A total of 155 patients were included in the study. LRR was observed in 22 patients (14.2%) with a median time to LRR of 17.1 months (interquartile range 6.3-26.3). Margin distance was found to be a predictor for LRR (hazard ratio 0.92, P = 0.033). The identified breakpoint for margin distance in this cohort was 19.8 mm. Compared to this cut-off, a margin distance of 15 mm increased the risk of LRR by 65% while 25 mm decreased the risk to LRR with 31%. A segmentectomy with a margin distance ≥ 20 mm resulted in significant improvements in overall survival (P = 0.020), lung cancer-specific survival (P = 0.010), and LRR-free survival (P < 0.001) when compared to cases with a margin distance < 20 mm.
Conclusions:
Margin distance ≥ 20 mm decreased LRR and improved survival outcomes for thoracoscopic segmentectomy in this study.
[CITATION]: Huang L, Petersen RH. Impact of margin distance on locoregional recurrence and survival after thoracoscopic segmentectomy. Ann Thorac Surg. 2024 Jul 25:S0003-4975(24)00581-2.
[DOI]: 10.1016/j.athoracsur.2024.07.012
[IF]: 3.6
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胸腔镜肺段切除术后切缘距离对局部区域复发及生存的影响
胸“星”外科学术团队兴趣小队成员 陈嘉玲 译
背景
方法
本研究回顾性分析了2008年1月至2023年2月在单中心前瞻性连续收集的胸腔镜肺段切除术患者数据。LRR的调整Cox回归模型的限制性立方样条显示了切缘距离的截断值。采用Kaplan-Meier法与log-rank检验评估了根据截断值分层两组的总体生存，通过Aalen-Johansen法和Gray’s检验评估了竞争模型中的无LRR生存和肺癌特异性生存。
结果
结论
Table 3. Multivariable Cox regression analysis for predicting locoregional recurrence.
Figure 3. Effect of margin distance on overall survival (OS) (A), lung cancer-specific survival (LCSS) (B) and locoregional recurrence-free survival (LRRFS) (C). 5-y: 5-year; 95% CI: 95% confidence interval.
2017·EATTS
02
Lung Adenocarcinoma Manifested as Ground Glass Nodules in Teenagers: Characteristics, Surgical Outcomes, and Management Strategies
Yi Ma1, Xiang Fei1, Chao Jiang1, Haiming Chen2, Ziming Wang1, Yi Bao1
1 Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
2 Department of Thoracic Surgery, Peking University People’s Hospital, Beijing, 100044, China
Objective:
Ground glass nodules featured lung cancer have been identified in some teenagers in recent years. This study aims to investigate the characteristics and surgical outcomes of these patients and explore proper management strategy.
Methods:
Patients aged ≤20 with incidentally diagnosed lung cancer were retrospectively reviewed from February 2016 to March 2023. Based on lymph node evaluation status, these patients were divided into non-lymph node evaluation and lymph node evaluation groups. The clinical and pathological characteristics were analyzed.
Results:
A total of 139 teenage patients were included, with an obviously increased cases observed from 2019, corresponding to the COVID-19 pandemic. The median age of the 139 patients was 18 years (range 12-20). 85 patients had pure ground glass nodules while others had mixed ground glass nodules. The mean diameter of nodules was 8.87±2.20 mm. Most of the patients underwent wedge resection (64%) or segmentectomy (31.7%). 52 patients underwent lymph node sampling or dissection. None of these patients had lymph node metastasis. The majority of lesions were adenocarcinoma in situ (63 cases) and minimally invasive adenocarcinoma (72 cases), while 4 lesions were invasive adenocarcinoma. The median follow-up time was 2.46 years, and none of these patients experienced recurrence or death during follow up. The lymph node evaluation group had longer hospital stays (P < 0.001), longer surgery time (P < 0.001), and greater blood loss (P = 0.047) than the non-lymph node evaluation group.
Conclusion:
The COVID-19 pandemic significantly increased the number of teenage patients incidentally diagnosed with lung cancer, presenting as ground glass nodules on CT scans. These patients have favorable surgical outcomes. We propose a management strategy for teenage patients, and suggest that sublobar resection without lymph node dissection may be an acceptable surgical procedure for these patients.
[CITATION]: Ma Y, Fei X, Jiang C, et al. Lung Adenocarcinoma Manifested as Ground Glass Nodules in Teenagers: Characteristics, Surgical Outcomes, and Management Strategies, Eur J Cardiothorac Surg, 2024 Jul 29.
[DOI]: 10.1093/ejcts/ezae291.
[IF]: 3.1
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青少年中以磨玻璃结节为特征的肺腺癌：特征、手术结局和管理策略
胸“星”外科学术团队兴趣小队成员 杨吉兮 译
目的
方法
结果
结论
Figure 1. The time distribution of the number of teenager patients enrolled in the study.
Figure 2. Representative cases.
2017·EATTS
