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Objective: This study aimed to investigate and analyze the clinical application value of thoracoscopic segmentectomy and lobectomy in patients with invasive pulmonary adenocarcinoma. Methods: 286 patients with invasive pulmonary adenocarcinoma who underwent segmentectomy or lobectomy at the First Hospital of Jiaxing City from January 2018 to June 2020 were retrospectively analyzed. Patients were divided into a thoracoscopic segmentectomy group(n=97) and a lobectomy group (n=189). Patients were compared after obtaining 1:1 propensity score-matched cohorts. Outcome indicators included surgery-related indicators, immune-inflammation-related indicators, postoperative complications, recurrence, and metastasis. Results: After 1:1 propensity score matching, 93 patients were included in each group. We found that the volume of intraoperative blood loss in the segmentectomy group was significantly less than in the lobectomy group (P=0.014). The duration of postoperative drainage (P = 0.005) and hospitalization (P=0.002) in the segmentectomy group were significantly shorter than in the lobectomy group. In terms of immunoinflammatory response, compared with the lobectomy group, white blood cells, neutrophils, SII, and NLR in the segmentectomy group were significantly lower than in the lobectomy group (P< 0.05). The recurrence-free survival (RFS) rates in the segmentectomy and lobectomy were 80.5% and 88.2% at 1 year and 35.1% and 52.6% at 3 years, respectively, and the difference was statistically significant (P<0.05). The segmentectomy group achieved similar outcomes to the lobectomy group at 1 year and 3 years (P > 0.05). Multivariate COX regression analysis showed that CAR was an independent risk factor for RFS in patients undergoing invasive adenocarcinoma surgery. Conclusion: Compared with lobectomy, thoracoscopic segmentectomy can effectively reduce the postoperative inflammatory response in patients with early invasive lung adenocarcinoma and promote patient recovery. Although segmentectomy is associated with a higher recurrence rate in the short term for patients with early invasive lung adenocarcinoma, the associated survival rate is similar to the lobectomy group. Segmentectomy should be considered in the treatment of early invasive lung adenocarcinoma. Meanwhile, postoperative CAR represents an independent risk factor for early postoperative recurrence in patients with IAC.
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BACKGROUND: Primary mediastinal germ cell tumor (PMGCT) is a rare but occasionally highly invasive mediastinal tumor. At present, there are few related disease special survival (DSS) studies on PMGCT, rare large data analysis, and uncommon DSS prognostic models. This study was to investigate the prognostic factors of DSS of the PMGCT patients, and build a simple and effective nomogram to predict the DSS prognosis in patients with PMGCT. METHODS: Retrospective clinicopathological data of 325 patients with PMGCT from 1975 to 2019 were extracted from Surveillance, Epidemiology, and End Results (SEER) database. The Kaplan-Meier method along with the Log-rank test were utilized to estimate the DSS. Cox proportional hazard regression model was used to screen the independent risk factors affecting prognosis, from which an individualized nomogram was constructed to predict 3-yr, 5-yr and 8-yr DSS of patients with PMGCT. The prediction accuracy of the model is evaluated by receiver operating characteristic (ROC) curve, correction curve and decision curve analysis (DCA) curve. RESULTS: The 3-yr, 5-yr and 8-yr survival rates of PMGCT were 84.6%, 83.6% and 83.3%, respectively. Univariate analysis showed that histology, surgery, age, tumor size, metastasis and stage could affect the prognosis of PMGCT. Multivariate analysis showed that histology, surgery, age and tumor size were independent risk factors for the prognosis of PMGCT patients, and the nomogram was constructed using these independent risk factors. The area under the curve (AUC) of ROC curve was 0.824. The results of the correction curves of 3-yr, 5-yr and 8-yr survival time and DCA, indicated that there was a good consistency between the predicted results of the nomogram evaluation and the real results. CONCLUSIONS: Patients with histological classification of seminoma in PMGCT have a better prognosis than patients with non-seminoma. The prognosis of patients with over the age of 40 yr, tumor size ≥15 cm and without surgical treatment was even worse. The nomogram model can accurately and intuitively predict the DSS of patients with PMGCT.
