Risk factors for recurrence after sublobar resection in patients with small (2 cm or less) non-small cell lung cancer presenting as a solid-predominant tumor on chest computed tomography

Abstract

Background: Sublobar resection is considered controversial for non-small cell lung cancer (NSCLC) presenting as a solid-predominant nodule. The aim of this study was to identify risk factors related to recurrence in small-sized NSCLC presenting as a solid-predominant nodule. Methods: We conducted a retrospective chart review of 118 patients who were treated for clinical N0 NSCLC sized ≤2 cm and who underwent sublobar resection with clear resection margins. We assigned them to two groups according to radiologic features: ground glass opacity (GGO)-predominant tumor and solidpredominant tumor. Clinicopathological characteristics and survival were analyzed in both groups. Risk factors for recurrence were analyzed in the solid-predominant tumor group. Results: Seventy-three patients had a GGO-predominant tumor, and 45 patients had a solid-predominant tumor. Five-year recurrence-free survival (RFS) in the solid-predominant tumor and GGO-predominant tumor groups was 64.9% and 95.5%, respectively. A multivariate analysis was performed to determine factors associated with recurrence after sublobar resection in the solid-predominant tumor group; it indicated that SUVmax [hazard ratio (HR) =1.482, 95% confidence interval (CI): 1.123-1.956, P=0.005] and histologic types other than adenocarcinoma (squamous cell carcinoma, HR =8.789, 95% CI: 1.572-49.134, P=0.013; other types, HR =53.569, 95% CI: 2.616-1096.849, P=0.010) were significant risk factors for recurrence.Conclusions: Risk factors in solid-predominant tumors sized ≤2 cm after sublobar resection are a high SUVmax and histologic types other than adenocarcinoma. Thus, lobectomy should be considered for solidpredominant NSCLC sized ≤2 cm with a high SUVmax or non-adenocarcinoma types.

Solid component ratio influences prognosis of GGO-featured IA stage invasive lung adenocarcinoma

“…Su H et al also found that no difference between lobectomy and limited resection was revealed in the GGO-predominant IA stage adenocarcinoma group [ 18 ]. Similar results could also be found in previous studies [ 23 , 24 ]. However, Ye T et al indicated that wedge resection may be inadequate for invasive lung adenocarcinoma ≤2 cm, with GGO features [ 14 ].…”

Preoperative consolidation‐to‐tumor ratio is effective in the prediction of lymph node metastasis in patients with pulmonary ground‐glass component nodules

“…Our study found main tumor SUVmax > 2.5 as a risk factor for lymph node metastasis, but its predictive power was far less than previously reported, 14 possibly because GGO demonstrated a relatively lower SUVmax value than solid nodules on PET/CT, thus influencing clinical judgment.…”

“…Several reports have indicated CTR as a valuable prognostic factor. For example, Moon et al reported solid predominant tumor as a significant factor for tumor recurrence in patients undergoing sublobar resection 14 . In our study, all patients analyzed received lobectomy for a primary lung cancer, and all patients with lymph node metastasis had CTR > 60%.…”

Sublobar Resection in Stage IA Non–Small Cell Lung Cancer: Role of Preoperative CT Features in Predicting Pathologic Lymphovascular Invasion and Postoperative Recurrence

“…It is therefore important to elucidate optimal criteria for selecting patients for sublobar resection. Previous studies demonstrated risk factors for poor outcomes after sublobar resection [9,24,25]. Wedge resection (vs segmentectomy), microscopic positive surgical margin, surgical margin…”