Radical sublobar resection for small-sized non–small cell lung cancer: A multicenter study

Okada, Morihito; Koike, Teruaki; Higashiyama, Masahiko; Yamato, Yasushi; Kodama, Ken; Tsubota, Noriaki

doi:10.1016/j.jtcvs.2006.02.063

Cited by 652 publications

(533 citation statements)

References 30 publications

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“…SUBLOBAR RESECTIONS FOR SMALL SOLID AND PARTLY SOLID PERIPHERAL TUMOURS Indications Table 1 shows the most relevant data from 20 studies comparing lobectomy with sublobar resection [8,20,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. All but three were retrospective: one was a prospective but nonrandomised study [28] and two were prospective observational studies [20,34].…”

Section: Upper Lobementioning

confidence: 99%

“…In most studies, sublobar resections were indicated in patients with poor lung function, cardiac comorbidity, old age or previous lung surgery. However, in six studies from five different institutions, sublobar resections were intentional in patients who could otherwise tolerate a lobectomy [20,25,28,32,37,41]. Most studies were limited to patients with stage I tumours, but three also included higherstage tumours [30,34,40].…”

Section: Upper Lobementioning

confidence: 99%

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Sublobar resection for lung cancer

Rami–Porta

Tsuboi²

2008

European Respiratory Journal

101

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Sublobar resection for small lung cancers has been debated frequently and is still a controversial issue. The only randomised trial comparing lobectomy with sublobar resections found a significantly higher recurrence rate for the latter, but failed to show significant differences in survival, although survival was better for the lobectomy group. One meta-analysis and several nonrandomised comparisons have confirmed these results. In general, lobectomy and sublobar resections have similar 5-yr survival rates. Local recurrence after wedge resection is higher than after segmentectomy. However, for patients aged .71 yrs, lobectomy and wedge resection are associated with similar survival. For tumours of f2 cm, segmentectomy is equivalent to lobectomy, but survival after segmentectomy is worse if performed for larger tumours. For both segmentectomy and wedge resection, tumour margins should be o1 cm wide to avoid recurrence. For pure bronchioloalveolar carcinoma of f2 cm, diagnosed intraoperatively with certainty, sublobar resection seems equivalent to lobectomy, and because there is no nodal involvement, systematic nodal dissection may not be necessary. In case of doubt, however, lobectomy with systematic nodal dissection will ensure complete resection and adequate staging. More randomised trials are needed to confirm all these issues.

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Section: Upper Lobementioning

confidence: 99%

Section: Upper Lobementioning

confidence: 99%

Sublobar resection for lung cancer

Rami–Porta

Tsuboi²

2008

European Respiratory Journal

101

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“…We defined the TDR (%) as (1-[tumor area of the mediastinal windows/tumor area of the lung windows]) Â 100. 2,3,8 Surgically resected tumors were fixed in 10% formalin and embedded in paraffin. Sections including the largest cut were evaluated histopathologically using hematoxylin and eosin and elastica van Gieson staining.…”

Section: Methodsmentioning

confidence: 99%

“…2,3 The presence or absence of lymph node metastases as well as histologic findings such as lymphatic, vascular, and pleural invasion are indicators of the malignant aggressiveness of the tumor and therefore are significant determinants of surgical extent of resection. However, preoperatively defining the accurate extension and metastasis of tumors is quite difficult.…”

mentioning

confidence: 99%

“…2,3 Phase 3 randomized trials of experimental sublobar versus standard lobar resection for small, peripheral, non-small cell cancer of the lung have already been initiated in Japan (JCOG 0802/West Japan Oncology Group [WJOG] 4607L) and the United States (Cancer and Leukemia Group B [CALGB]-140503). The results of the current large, multicenter study demonstrated that maxSUV on PET/CT is a potentially promising parameter for determining the degree of malignancy of lung adenocarcinomas.…”

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Value of integrated positron emission tomography revised using a phantom study to evaluate malignancy grade of lung adenocarcinoma

Nakayama

Okumura

Daisaki³

et al. 2010

Cancer

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BACKGROUND:The malignant biological behavior of small-sized lung adenocarcinomas remains obscure, although understanding this feature is important for selecting appropriate treatment. In the current study, the authors evaluated malignancy grades of small adenocarcinomas using fluorodeoxyglucose-positron emission tomography/ computed tomography (PET/CT) in addition to high-resolution CT (HRCT) and pathological analysis in a multicenter setting. METHODS: A total of 201 patients with clinical T1N0M0 adenocarcinoma underwent PET/CT and HRCT followed by complete surgical resection. Associations between components of bronchioloalveolar carcinoma (BAC) in specimens and maximum standardized uptake values (maxSUV) on PET/CT and ground-glass opacity (GGO) ratios and tumor disappearance rate (TDR) on HRCT were analyzed, as well as associations between these findings and pathological features of the tumors. Variations in maxSUV among institutions and the underestimations derived from small tumors, which are limitations of PET performed in multicenter studies, were adjusted using a phantom study. RESULTS: The maxSUV, BAC ratio, TDR, and GGO ratio (in that order) reflected the grade of tumor invasiveness and lymph node metastasis. The maxSUV and BAC ratio were found to be significant prognostic predictors derived from disease-free survival curves. Although the BAC ratio was found to be significantly associated with preoperative radiographic parameters, the maxSUV, GGO ratio, and TDR (all P < .0001), the degree of correlation with maxSUV (correlation coefficient [R 2 ] ¼ 0.1699) was much weaker than that reported with the GGO ratio (R 2 ¼ 0.5860) or TDR (R 2 ¼ 0.5082). CONCLUSIONS: Phantom studies can overcome the difficulties of multicenter studies using PET. A higher maxSUV appears to reflect aggressive malignant behavior in clinical T1N0M0 adenocarcinomas, independent of BAC components. Preoperative PET/CT assessment in addition to HRCT could be used to construct hypotheses for a future clinical study of strategies for the treatment of patients with small lung adenocarcinoma. Cancer 2010;116:3170-7.

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Association of Survival With Adjuvant Chemotherapy Among Patients With Early-Stage Non–Small Cell Lung Cancer With vs Without High-Risk Clinicopathologic Features

Pathak

Goldberg

Canavan³

et al. 2020

JAMA Oncol

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IMPORTANCETumor size larger than 4 cm is accepted as an indication for adjuvant chemotherapy in patients with node-negative non-small cell lung cancer (NSCLC). Treatment guidelines suggest that high-risk features are also associated with the efficacy of adjuvant chemotherapy among patients with early-stage NSCLC, yet this association is understudied.OBJECTIVE To assess the association between adjuvant chemotherapy and survival in the presence and absence of high-risk pathologic features in patients with node-negative early-stage NSCLC. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study using data from the National Cancer Database included 50 814 treatment-naive patients with a completely resected node-negative NSCLC diagnosed between January 1, 2010, and December 31, 2015. The study was limited to patients who survived at least 6 weeks after surgery (ie, estimated median time to initiate adjuvant chemotherapy after surgery) to mitigate immortal time bias. Statistical analysis was performed from December 1, 2018, to February 29, 2020.EXPOSURES Adjuvant chemotherapy use vs observation, stratified according to the presence or absence of high-risk pathologic features (visceral pleural invasion, lymphovascular invasion, and high-grade histologic findings), sublobar surgery, and tumor size. MAIN OUTCOMES AND MEASURESThe association of high-risk pathologic features with survival after adjuvant chemotherapy vs observation was evaluated using Cox proportional hazards regression models.RESULTS Overall, 50 814 eligible patients with NSCLC (27 365 women [53.9%]; mean [SD] age, 67.4 [9.5] years]) were identified, including 4220 (8.3%) who received adjuvant chemotherapy and 46 594 (91.7%) who did not receive adjuvant chemotherapy. Among patients with tumors 3 cm or smaller, chemotherapy was not associated with improved survival (hazard ratio [HR], 1.10; 95% CI, 0.96-1.26; P = .17). For patients with tumors larger than 3 cm to 4 cm, adjuvant chemotherapy was associated with a survival benefit among patients who underwent sublobar surgery (HR, 0.72; 95% CI, 0.56-0.93; P = .004). For tumors larger than 4 cm to 5 cm, a survival benefit was associated with adjuvant chemotherapy only in patients with at least 1 high-risk pathologic feature (HR, 0.67; 95% CI, 0.56-0.80; P = .02). For tumors larger than 5 cm, adjuvant chemotherapy was associated with a survival benefit irrespective of the presence of high-risk pathologic features (HR, 0.75; 95% CI, 0.61-0.91; P = .004). CONCLUSIONS AND RELEVANCEIn this cohort study, tumor size alone was not associated with improved efficacy of adjuvant chemotherapy in patients with early-stage (node-negative) NSCLC. High-risk clinicopathologic features and tumor size should be considered simultaneously when evaluating patients with early-stage NSCLC for adjuvant chemotherapy.

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Radical sublobar resection for small-sized non–small cell lung cancer: A multicenter study

Cited by 652 publications

References 30 publications

Sublobar resection for lung cancer

Sublobar resection for lung cancer

Value of integrated positron emission tomography revised using a phantom study to evaluate malignancy grade of lung adenocarcinoma

Association of Survival With Adjuvant Chemotherapy Among Patients With Early-Stage Non–Small Cell Lung Cancer With vs Without High-Risk Clinicopathologic Features

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