The Role of Sublobar Resection for the Surgical Treatment of Non-Small Cell Lung Cancer

Outcomes and Survival for Early-Stage Non-Small Cell Lung Cancer Following Wedge Resection or Lobectomy: A Propensity Score-Matched Analysis Using a Novel Peruvian Registry

Background

Using a previously unreported Peruvian registry of patients treated for early-stage non-small cell lung cancer (NSCLC), this study explored whether wedge resection and lobectomy were equivalent regarding survival and impact on radiologic-pathologic variables.

Methods

This observational, analytical, longitudinal study used propensity score-matched (PSM) analysis of a single-center retrospective registry of 2,570 patients with pathologic stage I-II NSCLC who were treated with wedge resection (n=1,845) or lobectomy (n=725) during 2000-2020. After PSM, 650 cases were analyzed (resection, n=325; lobectomy, n=325) through preoperative and clinical variables, including patients with ≥1 lymph node removed. Kaplan-Meier curves and multivariable Cox proportional hazard models were created for 5-year overall survival (OS), disease-free survival (DFS), and locoregional-recurrence-free survival (LRFS).

Results

The principal complication was operative pain persisting >7 days for lobectomy versus wedge resection (58% vs. 23%, p=0.034) and shorter hospital stays for resection than for lobectomy (5.3 days vs. 12.8 days, p=0.009). The 5-year OS (84.3% vs. 81.2%, p=0.09) and DFS (79.1% vs. 74.1%, p=0.07) were similar and statistically insignificant between resections and lobectomies, respectively. LRFS was worse overall following wedge resection than lobectomy (79.8% vs. 91.1%, p<0.02). Nevertheless, in the PSM analysis, both groups experienced similar LRFS when the resection margin was >10 mm (90.9% vs. 87.3%, p<0.048) and ≥4 lymph nodes were removed (82.8% vs. 79.1%, p<0.011).

Conclusion

Both techniques led to similar OS and DFS at 5 years; however, successful LRFS required a wedge resection with a surgical margin and adequate lymph node removal to obtain outcomes similar to lobectomy.

Advances in lung cancer surgery: the role of segmentectomy in early-stage management

INTRODUCTION

The evolving landscape of surgical interventions for early-stage non-small cell lung cancer (NSCLC) necessitates a reassessment of the traditional gold standard of lobectomy versus emerging sublobar resections, prompting this critical narrative review.

AREAS COVERED

This review encompasses recent randomized controlled trials, notably JCOG0802/WJOG4607L and CALGB140503, comparing lobectomy and sublobar resections for early-stage NSCLC, focusing on tumor size and recurrence rates. It also discusses the importance of individualized decision-making, future research avenues, and technological advancements in lung cancer surgery.

EXPERT OPINION

In this rapidly evolving field, sublobar resections emerge as a viable alternative to lobectomy for tumors smaller than 2 cm in early-stage NSCLC, necessitating precise patient selection and ongoing technological advancements to optimize outcomes.

FKBP3, a poor prognostic indicator, promotes the progression of LUAD via regulating ferroptosis and immune infiltration

BACKGROUND

Ferroptosis was reported to possess the therapeutic potentials in various human cancers. In the present study, we explored the expression, clinical significance and the molecular mechanism of FK506 binding protein 3 (FKBP3) in the progression of lung adenocarcinoma (LUAD).

MATERIAL AND METHOD

Cox regression was performed to obtain the prognosis related to differentially expressed genes (DEGs) in LUAD datasets from TCGA. We also downloaded the ferroptosis-related gene datasets from GeneCards. Venn diagram was performed to find the intersecting genes and FKBP3 was selected as the targeted gene by analyzing the diagnostic and prognostic values of Top10 intersecting genes. Moreover, univariate and multivariate analyses were performed to evaluate the association between clinicopathological factors and survival rates. GO/KEGG and GSEA analysis was performed to explore the function of FKBP3 in LUAD progression. Protein-protein interaction (PPI) network was performed via STRING database and the top10 hub genes were selected. Finally, the relationship between FKBP3 and immune infiltration was explored by ssGSEA analysis.

RESULTS

Firstly, 184 genes associated with the prognosis of LUAD and ferroptosis were obtained. FKBP3 was found to be significantly associated with a poor overall survival rate of LUAD patients. Immunohistochemical staining results showed that FKBP3 was highly located in cytoplasm and membrane of cells in LUAD tissues. PPI network analysis results showed that HDAC1, YY1, HDAC2, MTOR, PSMA3, PIN1, NCL, C14orf166, PIN4, and LARP6 were the top10 hub genes. Furthermore, spearman analysis results showed that the expression of FKBP3 was positively correlated with the abundance of Th2 cells and T helper cells.

CONCLUSION

High level of FKBP3 was associated with poor prognostic outcomes of LUAD patients, which also inhibited immune infiltration in LUAD tissues. Additionally, FKBP3 was involved in regulating the ferroptosis process in LUAD patients. Thus, FKBP3 possessed the tumor promotion role might be involving in regulating ferroptosis and immune infiltration in LUAD progression.

The prognostic significance of lymph nodes in patients with pT1c33N0M0 non-small cell lung cancer: a retrospective study

Objective

The objective of this study was to appraise the prognostic impact of lymph nodes in patients diagnosed with pT1c33N0M0 non-small cell lung cancer (NSCLC) and to delve into the prognostic significance of lymph nodes located at the N1 lymph node station in this patient cohort.

Methods

A retrospective analysis of clinical data was conducted for 255 patients diagnosed with pT1c33N0M0 NSCLC. Lymph nodes were tabulated and categorized into three groups (0-10 nodes, 11-16 nodes, >16 nodes). Clinical data among these three groups of pT1c33N0M0 NSCLC patients were compared. We conducted both univariate and multivariate analyses to pinpoint the factors that impact the prognosis of patients with pT1c33N0M0 non-small cell lung cancer (NSCLC). Additionally, we employed receiver operating characteristic (ROC) curve analysis to pinpoint the optimal lymph node criteria at the N1 station for prognostic prediction in pT1c33N0M0 NSCLC patients.

Results

Within the cohort of 255 individuals afflicted with pT1c33N0M0 non-small cell lung cancer (NSCLC), a comprehensive tally of 3,902 lymph nodes was diligently established, yielding an average of 15.3 nodes for each patient. Multivariate analysis demonstrated that tumor size, T stage, and lymph nodes were independent factors significantly impacting the prognosis of pT1c33N0M0 NSCLC patients (P < 0.05). ROC curve analysis revealed an area under the curve of 0.6982 for predicting prognosis using N1 station in pT1c33N0M0 NSCLC patients. The maximum Youden index was observed at an N1 station of 2.7 nodes. Patients with N1 station ≥ three nodes had significantly better prognoses compared to those with < 3 nodes (both P < 0.05).

Conclusion

Lymph nodes serve as an independent prognostic factor for pT1c33N0M0 NSCLC patients. Detecting at least three or more lymph nodes at the N1 station is associated with a more favourable prognosis in pT1c33N0M0 NSCLC patients.

Assessment of the Functioning Profile of Patients with Lung Cancer Undergoing Lobectomy in Relation to the ICF Rehabilitation Core Set

Lung cancer often presents with pain and breathlessness, frequently necessitating surgical procedures, such as lung lobectomy. A pivotal component of postoperative care is rehabilitation, aimed not only at improving the clinical condition but also at influencing the patient's functional profile. In a study conducted at the Clinic of Thoracic Surgery and Respiratory Rehabilitation in the Regional Multispecialist Center for Oncology and Traumatology of the Nicolaus Copernicus Memorial Hospital in Lodz, the effectiveness of rehabilitation intervention was assessed in 50 patients (n = 27 M, n = 23 F) postlobectomy due to early stage nonsmall cell lung cancer (NSCLC). The International Classification of Functioning, Disability, and Health-ICF Rehabilitation Core Set was used to evaluate the functional profile, the modified Laitinen scale for pain assessment, and the modified Borg scale for breathlessness evaluation. Additionally, lung-expansion time was monitored. The significance level of the statistical tests in this analysis was set at α = 0.05. The study employed an analysis of the normality of the distributions of the numerical variables, reporting of variable distributions, estimation of differences between groups, estimation of differences within groups, estimation of the independence of categorical variables, and regression analysis. The research confirmed that rehabilitation partially improves the functional profile of patients and reduces the sensation of breathlessness postsurgery. The study highlighted the need for future research with a larger number of participants and an extended observation period to gain a deeper understanding of the impact of rehabilitation on patients after lung lobectomy procedures.