Which extent of surgical resection thoracic surgeons would choose if they were diagnosed with an early-stage lung cancer: a European survey

Is segmentectomy potentially adequate for clinical stage IA3 non-small cell lung cancer

OBJECTIVES

This study aims to identify the feasibility of segmentectomy for clinical stage IA3 (cIA3) vs cIA1-2 non-small cell lung cancer (NSCLC).

METHODS

We retrospectively analysed data of consecutive patients with segmentectomy for cIA NSCLC across three centres between January 2017 and December 2022. The stabilized inverse probability of treatment-weighting (IPTW) was employed to minimize potential confounding in baseline characteristics. Recurrence-free survival (RFS) differences were examined using Kaplan-Meier estimator with the log-rank test. The Cox regression model was applied to assess the average treatment effect (ATE) between two groups in RFS. Subgroup and sensitivity analyses were performed.

RESULTS

Of a total of 589 patients who underwent segmentectomy, 478 presented with cIA1-2 NSCLC while 111 presented with cIA3 NSCLC. In comparison with cIA1-2 cases, the cIA3 cohort were significantly older with poorer lung function and more comorbidity. The cIA3 NSCLC presented significantly invasive characteristics, with extensive tissues dissected. After median follow-up of 24.0 (interquartile range 12.5-40.1) months, we did not observe significant difference in RFS (3-year 73.4% vs 78.5%, P = 0.490; ATE: 1.17) between the cIA3 vs cIA1-2 groups. These findings were corroborated following the stabilized IPTW. Preoperative characteristics in the cIA3 subgroup were not related to RFS. In the sensitivity analysis, no difference in RFS was found between the two groups stratified by peripheral and central localization.

CONCLUSIONS

In well-selected patients with cIA3 NSCLC, segmentectomy leads to no statistical difference in oncologic outcomes compared to those observed in earlier stages in a relatively short follow-up period.

Oncologic outcomes after minimally invasive segmentectomy or lobectomy in patients with hypermetabolic clinical stage IA1-2 non-small cell lung cancer

Objective

To evaluate the oncologic outcome of patients with hypermetabolic tumors resected by segmentectomy or lobectomy.

Methods

This was a retrospective analysis of all consecutive patients with peripheral clinical stage IA1-2 non-small cell lung cancer (January 2017-June 2023) who underwent resection by segmentectomy or lobectomy in a single center. A hypermetabolic tumor was defined as a tumor with a positron emission tomography (PET) maximum standardized uptake value >2.5. Propensity score case-matching analysis was used to generate 2 balanced groups of patients with hypermetabolic tumors operated by segmentectomy or lobectomy. Four-year overall survival (OS), event-free survival (EFS), and cancer-specific survival were compared between the matched groups.

Results

A total of 164 segmentectomies and 234 lobectomies were analyzed. There were 91 (55%) hypermetabolic tumors in the segmentectomy group versus 178 in the lobectomy group (76%), P < .001. The comparison of the matched groups with hypermetabolic tumors showed a better 4-year OS after lobectomy compared with segmentectomy (lobectomy 87%; 95% confidence interval [CI], 76-93; segmentectomy, 67%; 95% CI, 49-80; P = .029). The 4-year EFS appeared to have a better trend after lobectomy (77%; 95% CI, 65-85) compared with segmentectomy (58%; 95% CI, 39-72), P = .088. The 4-year cancer-specific survival, however, was similar between the matched groups (lobectomy, 95%; 95% CI, 86-98 vs segmentectomy, 94%; 95% CI, 78-99, P = .79).

Conclusions

Early-stage peripheral hypermetabolic tumors are associated with poorer oncologic outcomes compared with less PET-avid tumors. Despite poorer OS and EFS after segmentectomy likely caused by cancer-unrelated deaths, cancer-specific survival in this high-risk group was similar after lobectomy or segmentectomy. In well-selected patients, a high PET maximum standardized uptake value should not be considered a contraindication to segmentectomy.