对接受不同术式I期STAS阳性肺腺癌患者生存分析
Survival Analysis of Stage I STAS-Positive Lung Adenocarcinoma Patients Undergoing Different Surgical Procedures
DOI: 10.12677/acm.2026.1672724, PDF,   
作者: 董燕峰, 刘世虎：青岛大学附属医院胸外科，山东 青岛；青岛大学青岛医学院，山东 青岛；王勇杰*：青岛大学附属医院胸外科，山东 青岛
关键词: 肿瘤通过气道播散；肺腺癌；手术方式；Tumor Spread through Air Spaces； Lung Adenocarcinoma； Surgical Approach
摘要: 背景资料：近年来，有关肿瘤通过气道播散(STAS)的研究成为热点，STAS的存在不仅是肺癌复发及预后的独立相关因素而且不同手术方式是否对STAS阳性I期肺腺癌(ADC)患者的生存产生影响仍不明确。方法：回顾性分析了2019年至2021年在青岛大学附属医院胸外科进行手术治疗并完整切除的pT1-2aN0M0 ADC患者，其中528例被病理证实存在STAS并被最终选入，采用倾向评分匹配法(PSM)对不同分组患者进行匹配。最后利用Kaplan-Meier分析和Cox比例风险回归模型用于评估手术方式是否能给存在STAS的患者带来生存获益。结果：对于存在STAS的I期ADC患者中，接受亚肺叶切除术和肺叶切除术的匹配后患者无复发生存期(RFS) (P = 0.0019)存在显著差异而在总生存期(OS) (P = 0.61)方面无显著差异，多变量分析证实了这一结果(肺叶切除术与亚肺叶切除术，OS:HR = 0.24，95%CI，0.10~0.56，P = 0.001；RFS:HR = 0.19，95%CI，0.11~0.34，P < 0.001)。结论：存在STAS的I期ADC患者，肺叶切除相对比于亚肺叶切除能够给患者带来更好的预后结局。
Abstract: Background: In recent years, research on tumor spreading through air spaces (STAS) has become a hot topic. The presence of STAS is not only an independent risk factor for lung cancer recurrence and prognosis, but it remains unclear whether different surgical approaches affect survival in patients with STAS-positive stage I adenocarcinoma of the lung (ADC). Methods: We conducted a retrospective analysis of patients with pT1-2aN0M0 ADC who underwent surgical resection with complete excision at the Department of Thoracic Surgery, Qingdao University Affiliated Hospital, between 2019 and 2021. Among them, 528 cases were pathologically confirmed to have STAS and were ultimately included in the study. Propensity score matching (PSM) was used to match patients across different groups. Finally, Kaplan-Meier analysis and Cox proportional hazards regression were used to assess whether surgical procedure type confers a survival benefit in patients with STAS. Results: Among stage I ADC patients with STAS, there was a significant difference in recurrence-free survival (RFS) (P = 0.0019) between matched patients who underwent sublobar resection and those who underwent lobectomy, whereas there was no significant difference in overall survival (OS) (P = 0.61). Multivariate analysis confirmed these findings (lobectomy vs. sublobar resection, OS: HR = 0.24, 95%CI, 0.10~0.56, P = 0.001; RFS: HR = 0.19, 95%CI, 0.11~0.34, P < 0.001). Conclusion: In stage I ADC patients with STAS, lobectomy is associated with better prognostic outcomes compared to sublobar resection.
文章引用：董燕峰, 刘世虎, 王勇杰. 对接受不同术式I期STAS阳性肺腺癌患者生存分析[J]. 临床医学进展, 2026, 16(7): 1977-1985. https://doi.org/10.12677/acm.2026.1672724

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