Clinical implications of the margin cytology findings and margin/tumor size ratio in patients who underwent pulmonary excision for peripheral non-small cell lung cancer

Sawabata, Noriyoshi; Maeda, Hitoshi; Matsumura, Akira; Ohta, Mitsunori; Okumura, Meinoshin

doi:10.1007/s00595-011-0031-6

Cited by 67 publications

(42 citation statements)

References 22 publications

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“…The mortality rate was also very low during this period, with a 5-YSR of 55-65% (median, 61%) for all ages [16][17][18][19][20] and 41% for aged patients.…”

Section: [6]mentioning

confidence: 77%

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Pulmonary wedge resection for clinical stage I non-small cell lung cancer: a review of a mini-invasive treatment

Sawabata¹,

Kawase²,

Takahashi³

et al. 2017

MIS

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Non-small cell lung cancer (NSCLC) is one of the leading causes of cancer-related deaths in the world. Therefore, there is a need to intensify treatments of these tumors. Because stage I NSCLC is a nonmetastatic disease, local therapies are indicated, among which surgery is the most commonly deployed strategy. Pulmonary wedge/sublobar resection is therefore discussed in comparison to stereotactic body radiation therapy for stage I lung cancer. Review of retrospective and prospective clinical trials reveal similar outcomes for both strategies, while a multicenter randomized prospective study comparing the efficacy of both therapies is on-going. Because the results of pulmonary wedge/sublobar resection may depend on tumor size, tumor-distance from surgical margin, tumor size-to-margin distance ratio, and margin cytology, prospective studies to evaluate the clinical implications of these factors, so as to inform patient prognostication, are recommended. Key words:Non-small cell lung cancer, wedge resection, sublobar resection, stage I, stereotactic body radiation therapy ABSTRACTArticle history:

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“…The mortality rate was also very low during this period, with a 5-YSR of 55-65% (median, 61%) for all ages [16][17][18][19][20] and 41% for aged patients.…”

Section: [6]mentioning

confidence: 77%

“…Sawabata et al [17] reported that both M/T and margin cytology findings were indicators of cancer recurrence and survival. In their series, all seven cases of surgical margin recurrences were associated with positive margin cytology results.…”

Section: ]mentioning

confidence: 99%

Pulmonary wedge resection for clinical stage I non-small cell lung cancer: a review of a mini-invasive treatment

Sawabata¹,

Kawase²,

Takahashi³

et al. 2017

MIS

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“…Hancock et al [11] identified 54512 NSCLC patients who underwent curative surgery between 2003 and 2006, of note, 5-year survival rate of stage pI patients with R1 margins decreased from 62% to 37% compared to patients with complete resection. Similarly, another study [10] also showed that patients with R1 margins have worse disease-free survival and 5-year survival. At present, the main method for confirming clean bronchial margins is still routine pathological diagnosis, however, roughly 20% of patients having no evidence of macroscopic or microscopic disease at the resected margins suffer from local recurrence after surgery [10].…”

Section: Introductionmentioning

confidence: 79%

Detection of oncogenic mutations in resected bronchial margins by next-generation sequencing indicates early relapse in stage IA lung adenocarcinoma patients

Zou

Liu

et al. 2017

Oncotarget

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Stage I non-small cell lung cancer (NSCLC) patients experience a relatively high rate of recurrence, ranging from about 30-35%. We hypothesized that this elevated risk of recurrence is due to the presence of tumor cells at bronchial margins which was undetected by conventional light microscopy. Patients with clinical stage IA (T1N0M0) NSCLC were enrolled in this study, which included 8 early-relapse(ER) and 6 no-relapse(NR) patients. Primary tumor, bronchial margin, and normal lung tissues were collected and sent to a central site for targeted next-generation sequencing analysis. All of the patients were lung adenocarcinoma. Gene mutations were identified in all tumor tissue samples (100%). Oncogenic mutations were identified in 87.5%(7/8) bronchial margins of early relapse patients, whereas only 16.7%(1/6) no-relapse (NR) patient of marginal tissue had identified gene mutation. Additionally, concordance between primary tumor and bronchial margins was relatively high, with 4 of 8 (50%) ER patients having at least one identical mutation. Moreover, according to the gene mutation status in marginal tissue, 87.5% (7/8) of patients with at least one gene mutation in the bronchial margins had local recurrence or metastasis, whereas only 16.7% (1/6) of patients without any mutation detected had signs of relapse, the recurrence rate was significantly higher than that of the negative mutation margin group ((p (log-rank) = 0.023). The existence of oncogenic mutations in bronchial margins may represent occult residual tumor and elevated risk of recurrence in early stage NSCLC patients. Thus, assessing molecular status in bronchial margins may help identify patients who might benefit from extensive surgery or adjuvant treatment.

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“…Regarding recurrence patterns, it is easy to imagine the increased incidence of surgical stump recurrence in limited surgery cases due to an insufficient margin between the resection line and the STAS (12,13). The adequate resection margin has been discussed, and a distance exceeding the main tumor diameter is generally recommended (14). Therefore, achieving an adequate surgical margin is considered to be applicable for STASpositive lung cancers, and this has also been established in previous reports (9)(10)(11).…”

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confidence: 99%

Tumor spread through air space, the clinical implications for T factor and effects on the disease recurrence and prognosis

2018

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Clinical implications of the margin cytology findings and margin/tumor size ratio in patients who underwent pulmonary excision for peripheral non-small cell lung cancer

Abstract: A pulmonary wedge resection for peripheral NSCLC should result in a negative malignant margin, which might be obtained from a sufficient tumor margin ratio of M/T ≥ 1.

Cited by 67 publications

References 22 publications

Pulmonary wedge resection for clinical stage I non-small cell lung cancer: a review of a mini-invasive treatment

Pulmonary wedge resection for clinical stage I non-small cell lung cancer: a review of a mini-invasive treatment

Detection of oncogenic mutations in resected bronchial margins by next-generation sequencing indicates early relapse in stage IA lung adenocarcinoma patients

Tumor spread through air space, the clinical implications for T factor and effects on the disease recurrence and prognosis

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