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Tian Q, Jia JY, Qin C, Zhou H, Zhou SY, Qin YH, Wu YY, Shi J, Duan SF, Feng F. Prediction of programmed death-1 expression status in non-small cell lung cancer based on intratumoural and peritumoral computed tomography (CT) radiomics nomogram. Clin Radiol 2024; 79:e1089-e1100. [PMID: 38876960 DOI: 10.1016/j.crad.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/25/2024] [Accepted: 05/10/2024] [Indexed: 06/16/2024]
Abstract
AIMS This study aimed to predict the expression of programmed death-1 (PD-1) in non-small cell lung cancer (NSCLC) using intratumoral and peritumoral computed tomography (CT) radiomics nomogram. MATERIALS AND METHODS Two hundred patients pathologically diagnosed with NSCLC from two hospitals were retrospectively analyzed. Of these, 159 NSCLC patients from our hospital were randomly divided into a training cohort (n=96) and an internal validation cohort (n=63) at a ratio of 6:4, while 41 NSCLC patients from another medical institution served as the external validation cohort. The radiomic features of the gross tumor volume (GTV) and peritumoral volume (PTV) were extracted from the CT images. Optimal radiomics features were selected using least absolute shrinkage and selection operator regression analysis. Finally, a CT radiomics nomogram of clinically independent predictors combined with the best rad-score was constructed. RESULTS Compared with the 'GTV' and 'PTV' radiomics models, the combined 'GTV + PTV' radiomics model showed better predictive performance, and its area under the curve (AUC) values in the training, internal validation, and external validation cohorts were 0.90 (95% confidence interval [CI]: 0.83-0.97), 0.85 (95% CI: 0.74-0.96) and 0.78 (95% CI: 0.63-0.92). The nomogram constructed by the rad-score of the 'GTV + PTV' radiomics model combined with clinical independent predictors (prealbumin and monocyte) had the best performance, with AUC values in each cohort being 0.92 (95% CI: 0.85-0.98), 0.88 (95% CI: 0.78-0.97), and 0.80 (95% CI: 0.66-0.94), respectively. CONCLUSION The intratumoral and peritumoral CT radiomics nomogram may facilitate individualized prediction of PD-1 expression status in patients with NSCLC.
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Affiliation(s)
- Q Tian
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu 226361, PR China.
| | - J Y Jia
- Department of Medical Imaging Center, The Affiliated Huaian NO.1 People's Hospital of Nanjing Medical University, Huaian 223300, Jiangsu, PR China.
| | - C Qin
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu 226361, PR China.
| | - H Zhou
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu 226361, PR China.
| | - S-Y Zhou
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu 226361, PR China.
| | - Y H Qin
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu 226361, PR China.
| | - Y Y Wu
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu 226361, PR China.
| | - Jian Shi
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu 226361, PR China.
| | - S F Duan
- GE Healthcare China, Shanghai 210000, PR China.
| | - F Feng
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong, Jiangsu 226361, PR China.
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Lin YH, Chen LW, Wang HJ, Hsieh MS, Lu CW, Chuang JH, Chang YC, Chen JS, Chen CM, Lin MW. Quantification of Resection Margin following Sublobar Resection in Lung Cancer Patients through Pre- and Post-Operative CT Image Comparison: Utilizing a CT-Based 3D Reconstruction Algorithm. Cancers (Basel) 2024; 16:2181. [PMID: 38927887 PMCID: PMC11201844 DOI: 10.3390/cancers16122181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/02/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
Sublobar resection has emerged as a standard treatment option for early-stage peripheral non-small cell lung cancer. Achieving an adequate resection margin is crucial to prevent local tumor recurrence. However, gross measurement of the resection margin may lack accuracy due to the elasticity of lung tissue and interobserver variability. Therefore, this study aimed to develop an objective measurement method, the CT-based 3D reconstruction algorithm, to quantify the resection margin following sublobar resection in lung cancer patients through pre- and post-operative CT image comparison. An automated subvascular matching technique was first developed to ensure accuracy and reproducibility in the matching process. Following the extraction of matched feature points, another key technique involves calculating the displacement field within the image. This is particularly important for mapping discontinuous deformation fields around the surgical resection area. A transformation based on thin-plate spline is used for medical image registration. Upon completing the final step of image registration, the distance at the resection margin was measured. After developing the CT-based 3D reconstruction algorithm, we included 12 cases for resection margin distance measurement, comprising 4 right middle lobectomies, 6 segmentectomies, and 2 wedge resections. The outcomes obtained with our method revealed that the target registration error for all cases was less than 2.5 mm. Our method demonstrated the feasibility of measuring the resection margin following sublobar resection in lung cancer patients through pre- and post-operative CT image comparison. Further validation with a multicenter, large cohort, and analysis of clinical outcome correlation is necessary in future studies.
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Affiliation(s)
- Yu-Hsuan Lin
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei 106, Taiwan; (Y.-H.L.); (L.-W.C.); (H.-J.W.)
| | - Li-Wei Chen
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei 106, Taiwan; (Y.-H.L.); (L.-W.C.); (H.-J.W.)
| | - Hao-Jen Wang
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei 106, Taiwan; (Y.-H.L.); (L.-W.C.); (H.-J.W.)
| | - Min-Shu Hsieh
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan;
| | - Chao-Wen Lu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan; (C.-W.L.); (J.-H.C.); (J.-S.C.)
| | - Jen-Hao Chuang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan; (C.-W.L.); (J.-H.C.); (J.-S.C.)
| | - Yeun-Chung Chang
- Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan;
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan; (C.-W.L.); (J.-H.C.); (J.-S.C.)
| | - Chung-Ming Chen
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei 106, Taiwan; (Y.-H.L.); (L.-W.C.); (H.-J.W.)
| | - Mong-Wei Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei 100, Taiwan; (C.-W.L.); (J.-H.C.); (J.-S.C.)
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Detterbeck FC, Mase VJ, Li AX, Kumbasar U, Bade BC, Park HS, Decker RH, Madoff DC, Woodard GA, Brandt WS, Blasberg JD. A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 2: systematic review of evidence regarding resection extent in generally healthy patients. J Thorac Dis 2022; 14:2357-2386. [PMID: 35813747 PMCID: PMC9264068 DOI: 10.21037/jtd-21-1824] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/05/2022] [Indexed: 11/06/2022]
Abstract
Background Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options (lobectomy, segmentectomy, wedge, stereotactic body radiotherapy, thermal ablation), weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making. Methods A PubMed systematic review from 2000-2021 of outcomes after lobectomy, segmentectomy and wedge resection in generally healthy patients is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons with at least some adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved. Results In healthy patients there is no short-term benefit to sublobar resection vs. lobectomy in randomized and non-randomized comparisons. A detriment in long-term outcomes is demonstrated by adjusted non-randomized comparisons, more marked for wedge than segmentectomy. Quality-of-life data is confounded by the use of video-assisted approaches; evidence suggests the approach has more impact than the resection extent. Differences in pulmonary function tests by resection extent are not clinically meaningful in healthy patients, especially for multi-segmentectomy vs. lobectomy. The margin distance is associated with the risk of recurrence. Conclusions A systematic, comprehensive summary of evidence regarding resection extent in healthy patients with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation on which to build a framework for individualized clinical decision-making.
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Affiliation(s)
- Frank C. Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Vincent J. Mase
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew X. Li
- Department of General Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Ulas Kumbasar
- Department of Thoracic Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Brett C. Bade
- Department of Pulmonary Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Henry S. Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Roy H. Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - David C. Madoff
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Gavitt A. Woodard
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Whitney S. Brandt
- Department of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Justin D. Blasberg
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
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Liu W, Lai H, Wang Z, Liu L. Does surgical margin affect recurrence and survival after sublobar pulmonary resection for lung cancer? Interact Cardiovasc Thorac Surg 2021; 34:1089-1094. [PMID: 34875036 PMCID: PMC9159438 DOI: 10.1093/icvts/ivab328] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 10/17/2021] [Accepted: 10/31/2021] [Indexed: 02/05/2023] Open
Abstract
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: How does surgical margin distance affect recurrence and survival after sublobar pulmonary resection for lung cancer? Altogether, 172 papers were found using the search strategy, of which 12 studies with 1946 stage I non-small-cell lung cancer (NSCLC) patients using sublobar resection (wedge resection or segmentectomy) represented to be the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. Overall, 11 cohort studies and 1 prospective study were included. Four cohort studies demonstrated positive prognostic significance of surgical margin with specific cut-off points in each paper (ranged from 9 to 15 mm). Two retrospective studies and 1 prospective study found that a margin-to-tumour ratio of ≥1 was associated with better cytology and prognosis results. Other 5 studies showed that larger margin distance provided a favourable prognosis for NSCLC patients with poor-prognostic factors, including solid-dominant type, high invasive component size and Spread through Air Spaces-positive subtype. After reviewing all the included articles, we conclude that the standard of margin distance of >10 mm or margin-to-tumour ratio ≥ 1 should be recommended for stage I NSCLC patients undergoing sublobar resection, especially in wedge resection. Patients with poor-prognostic factors like solid-predominant tumour or non-lepidic adenocarcinoma may benefit from larger margin distance and the proper margin distance for them still needs to be determined. For Spread through Air Spaces-positive patients, sublobar resection may not be the alternative to lobectomy.
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Affiliation(s)
- Weijing Liu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Hongjin Lai
- West China School of Medicine, Sichuan University, Chengdu, China.,Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zihuai Wang
- West China School of Medicine, Sichuan University, Chengdu, China.,Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Lunxu Liu
- West China School of Medicine, Sichuan University, Chengdu, China.,Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Chiang XH, Lu TP, Hsieh MS, Tsai TM, Liao HC, Kao TN, Chang CH, Lin MW, Hsu HH, Chen JS. Thoracoscopic Wedge Resection Versus Segmentectomy for cT1N0 Lung Adenocarcinoma. Ann Surg Oncol 2021; 28:8398-8411. [PMID: 34145505 DOI: 10.1245/s10434-021-10213-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/05/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The choice between wedge resection and segmentectomy as a sublobar resection method for patients with cT1N0 lung cancer remains debatable. This study aimed to evaluate the clinical outcomes after wedge resection and segmentectomy for patients with cT1N0 lung adenocarcinoma. METHODS The study enrolled 1002 consecutive patients with cT1N0 lung adenocarcinoma who underwent sublobar resection at the authors' institution between 2011 and 2017. A propensity score-matching analysis was used to compared the clinical outcomes between the wedge resection and segmentectomy groups. RESULTS Wedge resection was performed for 810 patients (80.8%), and segmentectomy was performed for 192 patients (19.2%). Wedge resection resulted in better perioperative outcomes than segmentectomy. The multivariate analysis showed that the significant risk factors for poor disease-free survival (DFS) were elevated preoperative serum carcinoembryonic antigen levels, total tumor diameter greater than 2 cm, and a consolidation-to-tumor (C/T) ratio higher than 50%. After propensity-matching, no differences in overall survival or DFS were noted between the two matched groups. However, subgroup analysis showed that segmentectomy was associated with better DFS than wedge resection (p = 0.039) for the patients with a tumor diameter greater than 2 cm and a C/T ratio higher than 50%. CONCLUSION Segmentectomy is the appropriate surgical method for sublobar resection in cT1N0 lung adenocarcinoma patients with a tumor diameter greater than 2 cm and a C/T ratio higher than 50%. Wedge resection may be a safe and feasible sublobar resection method for patients with a tumor diameter of 2 cm or smaller or a C/T ratio of 50% or lower.
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Affiliation(s)
- Xu-Heng Chiang
- Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan
| | - Tzu-Pin Lu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Min-Shu Hsieh
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tung-Ming Tsai
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan.,Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsien-Chi Liao
- Department of Traumatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tzu-Ning Kao
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Hong Chang
- Statistics Education Center, National Taiwan University, Taipei, Taiwan
| | - Mong-Wei Lin
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Hsao-Hsun Hsu
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jin-Shing Chen
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan.,Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Moon Y, Park JK, Lee KY. The Effect of Resection Margin Distance and Invasive Component Size on Recurrence After Sublobar Resection in Patients With Small (≤2 Cm) Lung Adenocarcinoma. World J Surg 2020; 44:990-997. [PMID: 31712844 DOI: 10.1007/s00268-019-05276-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND When performing sublobar resection for lung cancer, the margin distance should exceed the tumor size. However, instead of total tumor size, the 8th edition TNM staging system has adopted the size of invasive component for the T stage. The aim of this study was to determine whether the prognosis was satisfactory when the resection margin distance was greater than the invasive component size instead of the total tumor size. METHODS From 2008 to 2017, 193 consecutive patients were diagnosed with lung adenocarcinoma (invasive component size ≤2 cm) and underwent sublobar resection. We analyzed risk factors for recurrence using clinicopathological factors including margin/invasive component ratio (resection margin distance/invasive component size). RESULTS Mean tumor size was 1.4 (±0.5) cm and the mean invasive component size was 0.8 cm (±0.5). In the multivariate analysis, neither resection margin distance (cm) nor margin/tumor ratio (resection margin distance/tumor size) was significant risk factors for recurrence. On the other hand, the margin/invasive component ratio (hazard ratio =0.035, p = 0.043) and the SUVmax (hazard ratio =1.993, p = 0.033) were significant risk factors for recurrence. CONCLUSIONS When sublobar resection is performed for small (invasive component size ≤2 cm) adenocarcinomas of the lung, the resection margin distance should be larger than the invasive component size. Sublobar resection is not an appropriate treatment for lung adenocarcinoma with high SUVmax.
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Affiliation(s)
- Youngkyu Moon
- Department of Thoracic & Cardiovascular Surgery. Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea.
| | - Jae Kil Park
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyo Young Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Choi SY, Moon MH, Moon Y. The prognosis of small-sized non-small cell lung cancer with visceral pleural invasion after sublobar resection. Transl Cancer Res 2020; 9:6431-6443. [PMID: 35117251 PMCID: PMC8797775 DOI: 10.21037/tcr-20-1995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/03/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Sublobar resection is sometimes performed as a surgical treatment for small peripheral tumors. However, there is a question about whether sublobar resection is adequate treatment when visceral pleural invasion is diagnosed postoperatively. The purpose of this study was to evaluate the prognosis of patients with small-sized stage IB non-small cell lung cancer (NSCLC) after sublobar resection. METHODS From January 2010 to December 2018, 227 consecutive patients with eighth edition TNM stage IB NSCLC (per the joint staging system of the International Association for the Study of Lung Cancer and the American Joint Committee on Cancer) underwent curative surgery at a single center. Those patients were reviewed retrospectively. The clinicopathological characteristics and prognosis were compared between the sublobar resection group and the lobectomy group. The sublobar resection group included only small-sized (invasive component size ≤2 cm) NSCLC. RESULTS In all study patients, clinicopathological characteristics between the sublobar resection and lobectomy groups were not different except in maximum standardized uptake value (SUVmax) and invasive component size. The 5-year recurrence-free survival (RFS) rate was 80.7% after sublobar resection and 73.4% after lobectomy (P=0.349). The 5-year overall survival (OS) rate was 87.3% after sublobar resection and 84.8% after lobectomy (P=0.503). In patients with small-sized NSCLC, the clinicopathological characteristics were not different between the sublobar resection group and the lobectomy group. The 5-year RFS rate was 80.7% after sublobar resection and 72.3% after lobectomy (P=0.417). The 5-year OS rate was 87.3% after sublobar resection and 91.2% after lobectomy (P=0.956). Sublobar resection was not a risk factor for recurrence in the multivariate analysis. CONCLUSIONS The prognosis of sublobar resection in patients with small-sized stage IB NSCLC was comparable with lobectomy. Thus, additional completion lobectomy may not be essential in this setting, despite postoperative upstaging from T1 to T2a.
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Affiliation(s)
- Si Young Choi
- Department of Thoracic & Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mi Hyoung Moon
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Youngkyu Moon
- Department of Thoracic & Cardiovascular Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Divisi D, De Vico A, Zaccagna G, Crisci R. Lobectomy versus sublobar resection in patients with non-small cell lung cancer: a systematic review. J Thorac Dis 2020; 12:3357-3362. [PMID: 32642260 PMCID: PMC7330740 DOI: 10.21037/jtd.2020.02.54] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Surgery is the gold standard treatment of lung cancer. The minimally invasive technique does not only concern access to the chest but also the limits of parenchymal resection. The study debates on the safety and oncological adequacy of sublobar resections in bronchogenic carcinoma patients. A systematic analysis of the data in the literature was carried out, comparing the outcomes of patients with resectable non-small lung cancer (NSCLC) who underwent lobectomy or sublobar resection. These last interventions include both segmentectomies and wedge resections taking into consideration the following parameters: complications, relapse rate and overall survival. The complication rate is higher in patients underwent lobectomy compared to sublobar resection, especially in presence of high comorbidity index or octogenarian patients (overall values respectively between 0 and 48% and 0 and 46.6%). Contrarily, the relapse rate (6.2% to 32% vs. 3.6% to 53.4%) and overall survival (50.2% to 93.8% vs. 38.6% to 100%) are more favorable in patients undergoing lobectomy. Sublobar resections are particularly indicated in elderly patients and in patients with high comorbidity index or reduced respiratory functional reserve. However, pulmonary lobectomy still remains the safest and oncologically correct method in patients with good performance status or higher risk of recurrence.
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Affiliation(s)
- Duilio Divisi
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital of Teramo, Teramo, Italy
| | - Andrea De Vico
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital of Teramo, Teramo, Italy
| | - Gino Zaccagna
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital of Teramo, Teramo, Italy
| | - Roberto Crisci
- Thoracic Surgery Unit, University of L'Aquila, "G. Mazzini" Hospital of Teramo, Teramo, Italy
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Moon Y, Park JK, Lee KY, Kim ES. Prognosis after wedge resection in patients with 8 th edition TNM stage IA1 and IA2 non-small cell lung cancer. J Thorac Dis 2019; 11:2361-2372. [PMID: 31372273 DOI: 10.21037/jtd.2019.05.79] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background According to the 8th edition TNM classification for non-small cell lung cancer (NSCLC), tumor stage (T) is determined by the maximum size of the invasive component, without the lepidic component, and the T category has been further subdivided. We investigated the indications for wedge resection using the 8th edition TNM staging system, which measures only the size of the invasive component in tumor size. Methods We compared 5-year disease-free survival (DFS) rates in 429 consecutive patients with 8th edition stage IA1 and IA2 NSCLC who underwent lobectomy or wedge resection from 2007 to 2017. We also analyzed the risk factors for recurrence after surgical resection. Results There were no significant differences in clinicopathological factors or 5-year DFS in patients with stage IA1 disease (5-year DFS 95.0%, lobectomy, vs. 91.6%, wedge resection; P=0.435). For patients with stage IA2 tumors, the 5-year DFS was 88.3% after lobectomy and 74.0% after wedge resection (P=0.118). There were significant differences in clinicopathological characteristics between lobectomy and wedge resection groups in stage IA2 NSCLC. On multivariate analysis, serum CEA level [hazard ratio (HR) =1.040, P=0.046] and lymphovascular invasion (HR =2.664, P=0.027), but not wedge resection, were significant risk factors for recurrence in stage IA2 NSCLC. On multivariate analysis for recurrence risk after wedge resection in stage IA1 and stage IA2 NSCLC, only the width of the resection margin was associated with recurrence. Conclusions Wedge resection may be an acceptable procedure in stage IA1 NSCLC. When performing wedge resection, it is necessary to ensure a sufficient resection margin distance.
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Affiliation(s)
- Youngkyu Moon
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Kil Park
- Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - Kyo Young Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Sung Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, Republic of Korea
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