| ObjectiveRecently,due to the development of Thin-section Computed Tomography(TSCT)and the improvement of people’s awareness of health examination and living standards,more and more patients with early-stage non-small lung cancer(NSCLC)have been discovered,especially those with clinical stage IA(c IA).There is controversy regarding which lymph node dissection method should be used in patients with c IA stage lung cancer.We will compare the effects of systematic lymph node dissection(SLND)and lobe-specific lymph node dissection(L-SND)on the short-term and long-term outcomes of patients with c IA stage lung adenocarcinoma,so as to explore the clinical application of lobe-specific lymph node dissection in lymphadenectomy for c IA stage lung adenocarcinoma,and provide theoretical guidance for the selection of intraoperative lymph node dissection plan.And by analyzing the prognostic factors of postoperative recurrence in patients with c IA stage lung adenocarcinoma,it is helpful for early detection and treatment of recurrence and metastasis,thereby improving the survival prognosis of lung cancer patients.MethodsThe status of lymph node of 725 patients with c IA stage lung adenocarcinoma who underwent thoracoscopic radical resection in the Thoracic Surgery Department of the Affiliated Hospital of Qingdao University from January 2013 to August 2016 were retrospectively analyzed.The clinicopathological data were collected,including gender,age,smoking history,preoperative complications,tumor size,tumor site,tumor composition,surgical method,histological type,operative time,intraoperative blood loss,lymph node metastasis,postoperative complications,catheterization time and length of stay.Confounding factors were corrected by the propensity score matching(PSM),and 1:1matching was performed with a matching tolerance of 0.1.Finally,211 pairs of patients were successfully matched.The perioperative parameters and postoperative complications of the matched patients were analyzed,and the matched patients were followed up to calculate the Relapse-free Survival(RFS)and overall survival of each patient.The followup cut-off time was August 2021.IBM SPSS 25.0 software was used for statistical analysis,categorial variables were expressed as cases(%),and the comparisons between groups were performed by c(17)test or Fisher’s exact test.continuous variables of normal distribution were expressed as mean±standard deviation,and continuous variables of non-normal distribution were expressed as median(range)[M(min,max)].T-test or Wilcoxon rank sum test were used for comparison between groups.Kaplan-meier method and Logrank test were used to compare the recurrence free survival and overall survival(OS)of the lobe-specific lymph node dissection group and the systemic lymph node dissection group.Logrank test was further used to conduct univariate analysis of the influencing factors of postoperative recurrence in patients with lung adenocarcinoma(α=0.1).Statistically significant(P<0.1)and clinically significant indicators were incorporated into the Cox proportional hazards model,and then multivariate analysis was performed to calculate the adjusted HR value and 95% confidence intervals(CI).P<0.05 was considered to be statistically significant.Results725 patients with c IA stage lung adenocarcinoma were enrolled.Among them,252 were male and 473 were female,the median age was 62(31-69)years old.There are 228 patients in L-SND group and 497 patients in SLND group.After matching,there were 211 patients in each group and no significance differences in the incidence of postoperative complications(13.7% vs.10.9%,P=0.374),identification of metastatic positive lymph nodes(9.0% vs.12.3%,P=0.270),disease-free survival(86.60% vs.77.37%,P=0.492)and overall survival rate(97.50% vs.97.34%,P=0.961)were found between two groups,whereas operation time(135.38±32.42 min vs.163.85±39.40 min,P<0.001),intraoperative blood loss [100(10～400)vs.100(20～800),P < 0.001],intubation time [4(1～9)vs.4(1～18),P<0.001] and hospital stay(10.76±2.38 vs.12.31±3.28,P=0.003)in the L-SND group were found to be significantly lower or shorter than that in the SLND group.Conclusion1.The lobe-specific lymph node dissection group has similar effects with the systematic lymph node dissection group in the incidence of postoperative complications,pathological lymph node metastasis,recurrence-free survival and overall survival.2.Compared with the systematic lymph node dissection group,the lobe-specific lymph node dissection group has significant advantages in shortening the operative time,reducing the amount of intraoperative blood bloss,shortening intubation time and hospitalization.3.In patients with c IA stage lung adenocarcinoma,tumor with solid component and anatomic segmental resection are independent risk factors for postoperative recurrence,while lymph node dissection is not a negative factor for postoperative recurrence.Therefore,lobe-specific lymph node dissection can be recommended instead of systemic lymph node dissection as a dissection modality for lymph node resection in patients with c IA stage lung adenocarcinoma. |
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