초록접수 현황
| 15F-033 | 구연 발표 |
Recurrence Risk Factors for Early Stage Lung Adenocarcinoma Treated with Limited Resections.
이은주, 신경욱, 장효준, 조석기, 전상훈, 김관민
서울대학교 의과대학 분당서울대학교병원 흉부외과학교실
Background : Adoption of limited resections for the definite treatment of early stage lung cancer still remains in controversial. However, wedge resections and segmenctectomies have been more and more widely used for therapeutic choice. This study aimed to investigate the recurrence risk factors in patients with early stage lung adenocarcinoma who had undergone limited resections for their diseases.
Methods : A total of 886 patients underwent surgical treatments for their stage I lung adenocarcinomas between 2003 and 2013. Patients who had underwent neoadjuvant therapy, underwent bilobectomy, sleeve lobectomy and pneumonectomy were excluded. Enrolled patients were 871, and among those, patients who underwent wedge resections were 160 (18.4%), segmentectomies were75 (8.6%), and lobectomies were 636 (73.0%). Medical records of enrolled patients were reviewed retrospectively and prognostic factors were analyzed.
Results : Among the enrolled population, patients underwent limited resections (wedge or segmentectomy) were 235 (136 men, 99 women). The mean age was 61.9 (±11.2, ranged from 21 to 91) and mean follow-up periods were 45.9 (±21.3 ranged from 9.3 to 116.6). 185 patients were in stage IA (78.7%), and 216 patients (91.9%) underwent VATS surgeries. Fifteen patients had died during the follow-up periods (6.4%). Four cases of deaths were not related with disease progression or postoperative complications. 5-year overall survival rates was 92.4% and that of recurrence-free survival was 90.4%. 5-year overall survival and recurrence-free survival rates of patients with limited resections revealed no statistically significant differences with those of patients with lobectomies (p=0.375 for overall survival and 0.238 for recurrence-free survival). Recurrence rates estimated 8.5% (20 cases). In univariate analysis, SUVmax value, open thoracotomy, total tumor size, invasive tumor size, presence of visceral pleural invasion, micropapillary patterns, aerogenous spread, necrosis and absence of adjuvant chemotherapy were recurrence risk factors. However, in multivariate analysis, open thoracotomy and invasive tumor size were independent risk factors for recurrence. (p=0.015, and p=0.033 respectively.) Invasive tumor size with recurrences tends to be more than 1cm in diameter.
Conclusion : The prognosis of early stage lung adenocarcinomas which underwent limited resections are not inferior to that of lobectomies. Patients with lung adenocarcinomas expecting to contain invasive tumor size more than 1cm in diameter and need thoracotomy would be confronted with higher risks for recurrence if they undergo limited resections.
Methods : A total of 886 patients underwent surgical treatments for their stage I lung adenocarcinomas between 2003 and 2013. Patients who had underwent neoadjuvant therapy, underwent bilobectomy, sleeve lobectomy and pneumonectomy were excluded. Enrolled patients were 871, and among those, patients who underwent wedge resections were 160 (18.4%), segmentectomies were75 (8.6%), and lobectomies were 636 (73.0%). Medical records of enrolled patients were reviewed retrospectively and prognostic factors were analyzed.
Results : Among the enrolled population, patients underwent limited resections (wedge or segmentectomy) were 235 (136 men, 99 women). The mean age was 61.9 (±11.2, ranged from 21 to 91) and mean follow-up periods were 45.9 (±21.3 ranged from 9.3 to 116.6). 185 patients were in stage IA (78.7%), and 216 patients (91.9%) underwent VATS surgeries. Fifteen patients had died during the follow-up periods (6.4%). Four cases of deaths were not related with disease progression or postoperative complications. 5-year overall survival rates was 92.4% and that of recurrence-free survival was 90.4%. 5-year overall survival and recurrence-free survival rates of patients with limited resections revealed no statistically significant differences with those of patients with lobectomies (p=0.375 for overall survival and 0.238 for recurrence-free survival). Recurrence rates estimated 8.5% (20 cases). In univariate analysis, SUVmax value, open thoracotomy, total tumor size, invasive tumor size, presence of visceral pleural invasion, micropapillary patterns, aerogenous spread, necrosis and absence of adjuvant chemotherapy were recurrence risk factors. However, in multivariate analysis, open thoracotomy and invasive tumor size were independent risk factors for recurrence. (p=0.015, and p=0.033 respectively.) Invasive tumor size with recurrences tends to be more than 1cm in diameter.
Conclusion : The prognosis of early stage lung adenocarcinomas which underwent limited resections are not inferior to that of lobectomies. Patients with lung adenocarcinomas expecting to contain invasive tumor size more than 1cm in diameter and need thoracotomy would be confronted with higher risks for recurrence if they undergo limited resections.
책임저자: 김관민
서울대학교 의과대학 분당서울대학교병원 흉부외과학교실
연락처 : 이은주, Tel: 031-787-7146 , E-mail : viking99@hanmail.net
