A Nomogram to Predict Recurrence and Survival of High-Risk Patients Undergoing Sublobar Resection for Lung Cancer: An Analysis of a Multicenter Prospective Study (ACOSOG Z4032)

Abstract

Background Individualized prediction of outcomes may help with therapy decisions for patients with non-small cell lung cancer (NSCLC). We developed a nomogram by analyzing 17 clinical factors and outcomes from a randomized study of sublobar resection for NSCLC in high-risk operable patients. The study compared sublobar resection alone, to sublobar resection with brachytherapy. There were no differences in primary and secondary outcomes between the study arms, and were thus combined for this analysis. Methods The clinical factors of interest (considered as continuous variables) were assessed in a univariate Cox Proportional Hazards model for significance at the 0.10 level for their impact on overall survival (OS), local recurrence free survival (LRFS) and any recurrence free survival (RFS). The final multivariable model was developed using a stepwise model selection. Results 173 of 212 patients had complete data on all 17 risk factors. Median (range) follow-up was 4.94 (0.04–6.22) years. The 5-year OS, LRFS and RFS were 58.4%, 53.2% and 47.4% respectively. Age, baseline DLCO % and maximum tumor diameter were significant predictors for OS, LRFS and RFS in the multivariable model. Nomograms were subsequently developed for predicting 5-year OS, LFRS and RFS. Conclusions Age, baseline DLCO% and maximum tumor diameter significantly predicted outcomes after sublobar resection. Such nomograms may be helpful for treatment planning in early stage NSCLC and to guide future studies.

Segmentectomy Versus Wedge Resection for Stage I Non–Small Cell Lung Cancer: A Meta-analysis

“…Tsutani et al 3 found no statistically significant difference in overall survival (OS) or recurrence-free survival between patients treated by segmentectomy versus wedge resection for ground glass opacity (GGO)-dominant clinical stage Ia NSCLC. Similar results have been reported by Fiorelli et al, Hamatake et al, and Kent et al [4][5][6] Hou et al 7 conducted a meta-analysis of nine studies and found no significant difference in disease-free survival (DFS) of patients with stage I NSCLC receiving segmentectomy versus wedge resection. Some previous metaanalyses that have compared the clinical outcomes of lobectomy, segmentectomy, and wedge resection in patients with stage I NSCLC categorized segmentectomy and wedge resection together as "sublobar resection."…”

Lymph node dissection during sublobar resection: why, when and how?

“…A tremendously high proportion of patients, 40% to 70%, have not even one single LN removed or examined (35)(36)(37), and this proportion is worse following wedge resection when compared to segmentectomy (36). Even in the frame of the randomized ACOSOG Z4032 trial designed to specifically evaluate surgical outcomes, and comparing sublobar resection alone with sublobar resection with brachytherapy in patients with clinical stage I non-small lung cancer, more than one third of the patients did not receive any kind of LN evaluation (38). With this background, the incidence of regional recurrence after stereotactic body radiation therapy (SBRT) or surgery is intuitively expected to be comparable, as shown by the available evidence (39).…”

Near-Infrared Sentinel Lymph Node Identification in Non–Small Cell Lung Cancer

“…7 Sentinel lymph node mapping is particularly advantageous in the era of lung cancer screening during which small and semisolid nodules are subject to limited resection for diagnosis and therapy but still require accurate nodal staging. In addition, a limited nodal dissection facilitated by SLN mapping permits subsequent nodal staging if a second primary tumor occurs.…”