Reassessment of Right Middle Lobe Lung Cancer: Comparison of Segments 4 and 5 Tumors

Middle lobe tumors and lymphovascular invasion as independent predictors of recurrence-free survival in stage I NSCLC

BACKGROUND

Recurrence and metastases are prevalent in lung cancer, contributing to a concerning rate of treatment failure. As a result, there is a pressing need for multivariate analyses of prognostic utility in non-small cell lung cancer (NSCLC). This study reports on the factors influencing metastasis and recurrence-free survival (RFS) in patients with clinical stage I NSCLC who have undergone anatomic lung resection.

METHODS

This study included patients diagnosed with stage I NSCLC who received surgical treatment at our institution between January 2016 and December 2022. A careful examination was conducted of the patients' demographic, clinical, radiological, and histopathological data. The prognostic value of the recorded parameters was assessed according to recurrence and/or metastasis, considering RFS during follow-up assessments.

RESULTS

Among the 616 patients included in this study, the average age was 63 ± 8.9 years, with 506 (82.1%) of patients being male. During a median follow-up period of 50.4 ± 23.7 months (ranging from 1 to 89 months), 79 patients (12.8%) experienced recurrence or metastasis, while 41 patients (6.7%) died. Multivariate analysis showed no significant differences (p > 0.05) regarding recurrence or metastasis development when considering demographic characteristics, tumor size, operation forms, histopathologic types involved, perineural and visceral pleural invasion status, and aspects of oncological treatment. Conversely, the presence of lymphovascular invasion (p < 0.003) and tumor localization in the middle node (p < 0.045) emerged as significant predictors of RFS.

CONCLUSION

In patients with early-stage NSCLC, the presence of lymphovascular invasion and localization of the tumor in the middle lobe are independent predictors of RFS.

Survival rates of patients with tumors originating in different segments of the left upper lung in stage I to III non-small cell lung cancer

Background

The aim of this research was to evaluate the effect of spatial location of tumors on the prognosis of patients with left upper lung non-small cell lung cancer (NSCLC), with a focus on the S1+2+3 and lingual segment.

Methods

A total of 486 patients who underwent lobectomy and systematic lymph node dissection were collected retrospectively in this study (354 S1+2+3 and 132 lingual segment patients). Factors impacting survival were assessed via univariate analyses, multivariate analyses, and log-rank tests.

Results

Compared with tumor location in S1+2+3, lingual segment tumor location of stage II to III left upper lung NSCLC patients was significantly associated with a better 5-year disease-free survival (DFS) (P=0.041). Multivariate analysis results showed that tumor location in the lingual segment was a good independent prognostic factor of stage II to III left upper lung NSCLC patients [hazard ratio (HR) =0.602, 95% confidence interval (CI): 0.149-0.865, P=0.006). However, in stage I left upper lung NSCLC, tumor location (HR =1.069, 95% CI: 0.571-2.000, P=0.835) was not an independent prognostic factor, and only T2 (HR =2.422, 95% CI: 1.271-4.620, P=0.007) was an independent worse prognosis factor.

Conclusions

Tumor location in the lingual segment of left upper lung stage II to stage III NSCLC is a good independent prognostic factor compared with S1+2+3. Nevertheless, tumor location does not impact the prognosis of patients with stage I NSCLC in the left upper lung.

Segment Location and Ground Glass Opacity Ratio Reliably Predict Node-Negative Status in Lung Cancer

BACKGROUND

Although selective mediastinal lymph node dissection based on lobe-specific nodal metastasis has been proposed for non-small cell lung cancer, controversy remains over its validity. We hypothesized that different segments within the same lobe might have different patterns of lymph node metastasis.

METHODS

Data on 2749 invasive non-small cell lung cancer patients who underwent pulmonary resection with systematic lymph node dissection from April 2008 to December 2015 were retrospectively analyzed. The segment location and consolidation tumor ratio were identified using preoperative computed tomography scans.

RESULTS

None of the 151 tumors with consolidation tumor ratio ≤ 0.5 had lymph node involvement. None of the 333 tumors located in apical segments had inferior mediastinal lymph node metastasis. When the analysis was limited to patients without hilar nodes involvement, only 7 out of 740 (0.9%) peripheral upper lobe tumors had inferior mediastinal lymph node metastasis. Interestingly, all these 7 tumors showed visceral pleural invasion. If hilar nodes were negative, superior mediastinal lymph node metastasis was not present for lower lobe ground glass opacity lesions. Among patients with left lower lobe tumors, if hilar nodes were negative, station 4L lymph node metastasis was not found in superior-segment or basal-segment tumors, and station 5/6 lymph node involvement was always absent in basal-segment tumors.

CONCLUSIONS

Segment location, ground glass opacity proportion, and absence of hilar lymph nodes involvement are reliable predictors of node-negative status in specific mediastinal regions. Based on these findings, we propose a new selective mediastinal lymph node dissection strategy for non-small cell lung cancer.

Lobectomy versus sub-lobar resection in patients with stage IA right middle lobe non-small cell lung cancer: a propensity score matched analysis

Background

The aim of the present study was to compare the prognostic outcomes of patients with stage IA right middle lobe non-small cell lung cancers (RML NSCLCs) that underwent either lobectomy (LR) or sub-lobar resection (SLR) after 1:1 propensity score matching (PSM).

Methods

Patients with stage IA RML NSCLC were identified from the Surveillance, Epidemiology and End Results (SEER) database from 2005 to 2015. Cox regression analysis was carried out to compare lung cancer specific survival (LCSS) following LR or SLR before and after PSM. Subgroup analysis of LCSS stratified by tumor size (≤1, 1-2, and 2-3 cm) was also performed.

Results

A total of 1,104 patients met the inclusion criteria. One hundred ninety-eight (17.9%) patients underwent SLR, and 906 (82.1%) underwent LR. There were significant differences between patients of LR and SLR groups with regard to the tumor size and the number of examined lymph nodes. After PSM, 147 matched pairs (n=294) were selected. Multivariable cox regression analysis revealed no difference in the LCSS of patients that underwent either LR or SLR before [hazard ratio (HR): 0.881, 95% CI: 0.547-1.422, P=0.605] and after PSM (HR: 0.778, 95% CI: 0.409-1.480, P=0.444). Subgroup analysis revealed no significant difference in LCSS between patients of LR and SLR groups with regard to the tumor size (all P>0.05).

Conclusions

Similar to lymphadenectomy, the prognostic outcomes in patients with stage IA RML NSCLC were comparable between LR and SLR.

Survival rates after lobectomy versus sublobar resection for early-stage right middle lobe non-small cell lung cancer

Background

Lung cancer in the right middle lobe has a poorer prognosis than tumors located in other lobes. The optimal surgical procedure for early‐stage non‐small cell lung cancer (NSCLC) in the right middle lobe has not yet been elucidated. The aim of this study was to compare survival rates after lobectomy and sublobar resection for early‐stage right middle lobe NSCLC.

Methods

Patients who underwent lobectomy or sublobar resection for stage IA right middle lobe NSCLC tumors ≤ 2 cm between 2004 and 2014 were identified from the Surveillance, Epidemiology and End Results database of 18 registries. Cox regression model analysis was used to evaluate the prognostic factors. The lung cancer‐specific survival (LCSS) and overall survival (OS) rates between the two groups were compared.

Results

A total of 861 patients met our criteria, including 662 (76.9%) patients who underwent lobectomy and 199 (23.1%) patients who underwent sublobar resection. No statistical differences in LCSS and OS rates were identified between the groups of patients with stage IA right middle lobe NSCLC ≤ 1 cm. For tumors > 1–2 cm, lobectomy was associated with more favorable LCSS and OS rates compared to sublobar resection.

Conclusion

Lobectomy and sublobar resection deliver a comparable prognosis for patients with stage IA right middle lobe NSCLC ≤ 1 cm. For tumors > 1–2 cm, lobectomy showed better survival rates than sublobar resection.