目的 探究解剖性肺段切除术治疗影像学与病理学“双高危”IA期（≤2cm）肺腺癌的肿瘤学疗效。  

方法  回顾性收集自2016年11月至2021年10月在中国医学科学院肿瘤医院胸外科接受手术切除的临床IA期（≤2 cm）原发非黏液性肺腺癌患者的临床、病理和随访信息。比较解剖性肺段切除术和肺叶切除术治疗影像学纯实性且携带病理高危因素的“双高危”肺腺癌的术后累计复发率（cumulative incidence of recurrence, CIR）和累计肺癌特异性死亡率（lung cancer-specific cumulative incidence of death, LC-CID）。  

结果   纳入746例患者，其中肺段组112例,肺叶组634例。相较于肺叶组，肺段组肿瘤最大径(1.3cm vs. 1.6cm, p<0.001)和浸润成分最大径(1.2cm vs. 1.5cm, p<0.001)更小，肿瘤存在脉管侵犯(8.4% vs. 13.1%, p=0.23）和脏层胸膜侵犯（22.2% vs. 39.8%, p<0.001）的占比更低,但携带高级别病理亚型（87.5% vs. 79.0%, p=0.051）和气腔播散(36.1% vs. 22.7%, p=0.004)的占比更高。倾向性评分匹配后，肺段组（n=102）的5年CIR（12.8% vs. 11.0%, p=0.87）和5年LC-CID(6.4% vs. 5.0%, p>0.99)与肺叶组（n=191）无显著差异。然而，在高龄（>65岁）和具有吸烟史的患者亚组，肺段组的5年CIR（26.5% vs. 11.1%, p=0.03；25.5% vs. 13.1%, p=0.055）高于肺叶组。在多因素竞争风险回归模型中，肿瘤最大径增加（p=0.014）和高级别病理亚型占比增加(p=0.043)是肿瘤复发独立危险因素。  

结论  肺段切除可以作为周围型cT1a-bN0M0、纯实性肺腺癌的标准治疗方案，但应确保足够的安全切缘以及进行妥当的淋巴结清扫，以降低术后复发率，保证患者的远期预后。

Objective To evaluate the oncological efficacy of anatomic segmentectomy for radiological and pathological “bi-risk” stage IA (≤2cm) lung adenocarcinoma.  

Methods  This retrospective study analyzed clinical, pathological, and follow-up data of patients with clinical stage IA (≤2 cm) primary non-mucinous lung adenocarcinoma who underwent surgical resection at Department of Thoracic Surgery of Cancer Hospital, Chinese Academy of Medical Sciences from November 2016 to October 2021. Cumulative incidence of recurrence (CIR) and cumulative incidence of lung cancer-specific death (LC-CID) were compared between segmentectomy and lobectomy groups in patients with "bi-risk" lung adenocarcinoma (radiologically pure-solid tumors with pathological high-risk features).  

Results  Among 746 patients (112 undergoing segmentectomy and 634 undergoing lobectomy), the segmentectomy group had smaller maximum tumor diameter (1.3 cm vs. 1.6 cm, p<0.001) and pathological invasive size (1.2 cm vs. 1.5 cm, p<0.001), lower rates of lymphovascular invasion (8.4% vs. 13.1%, p=0.23) and visceral pleural invasion (22.2% vs. 39.8%, p<0.001), but higher frequencies of high-grade histological subtypes (87.5% vs. 79.0%, p=0.051) and tumor spread through air space (36.1% vs. 22.7%, p=0.004). After propensity score matching (102 segmentectomy vs. 191 lobectomy), no significant differences were observed in 5-year CIR (12.8% vs. 11.0%, p=0.87) or LC-CID (6.4% vs. 5.0, p>0.99). However, subgroup analyses revealed higher 5-year CIR in segmentectomy patients aged >65 years (26.5% vs. 11.1%, p=0.03) and those who ever smoked (25.5% vs. 13.1%, p=0.055). Multivariate competing risk regression identified increased maximum tumor diameter (p=0.014) and increased proportion of high-grade histological subtypes (p=0.043) as independent predictors of increased tumor recurrence.  

Conclusions  Anatomic segmentectomy may serve as a standard treatment for cT1a-bN0M0, pure-solid lung adenocarcinomas ≤2 cm. Ensuring adequate resection margins and sufficient lymph node dissection is critical to reduce recurrence and improve long-term outcomes.