Segmentectomy Provides Comparable Outcomes to Lobectomy for Stage IA Non-small Cell Lung Cancer with Spread through Air Spaces

Ikeda, Toshihiro; Kadota, Kyuichi; Go, Tetsuhiko; Misaki, Noriyuki; Haba, Reiji; Yokomise, Hiroyasu

doi:10.1053/j.semtcvs.2022.02.001

Cited by 14 publications

(7 citation statements)

References 28 publications

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“…Based on the findings of univariate Cox proportional hazard model, higher T and N categories, higher clinical stage, presence of pleural and lymphovascular invasion, “high STAS” category, presence of FTC were associated with unfavourable OS and RFS estimates. These results are consistent with the findings of the abovementioned studies [ 21 , 22 , 23 , 24 ]. Concerning the multivariate analysis, higher T category, presence of lymphovascular invasion, and FTC were associated with adverse OS prognosis.…”

Section: Discussionsupporting

confidence: 94%

“…Aerogenic spread, first described by Cain [ 17 ], is present in primary and secondary neoplasms of the lung; however, this form of tumour spread is more frequent among primary pulmonary adenocarcinomas and thereby has been extensively studied. Clinicopathological parameters related to the STAS1 have been reported in several adenocarcinoma cohorts [ 18 , 19 , 20 , 21 , 22 ]. Kadota and co-workers [ 7 ] have examined 411 resected stage I lung adenocarcinomas.…”

Section: Discussionmentioning

confidence: 99%

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The More Extensive the Spread through Air Spaces, the Worse the Prognosis Is: Semi-Quantitative Evaluation of Spread through Air Spaces in Pulmonary Adenocarcinomas

Zombori-Tóth¹,

Paróczai²,

Lantos

et al. 2022

Pathobiology

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Introduction: The extent of spread through air spaces (STAS) is less investigated among patients with lung adenocarcinoma who underwent sublobar resection. Therefore, we aimed to evaluate the extent of STAS semi-quantitatively, to assess its prognostic impact on overall survival (OS) and recurrence-free survival (RFS), and to investigate the reproducibility of this assessment. Methods: The number of tumour cell clusters and single tumour cells within air spaces was recorded in three different most prominent areas (200x field of view). The extent of STAS was categorized into three groups, and the presence of free tumour cluster (FTC) was recorded. Results: Sixty-one patients were included. Recurrence was more frequent with higher grade (p = 0.003), presence of lymphovascular invasion (p = 0.027), and presence of STAS of any extent (p = 0.007). In multivariate analysis, presence of FTC (HR: 5.89; 95% CI: 1.63–21.26; p = 0.005) and more pronounced STAS (HR: 7.46; 95% CI: 1.60–34.6; p = 0.01) had adverse impact on OS and RFS, respectively. Concerning reproducibility, excellent agreement was found among STAS parameters (ICC range: 0.92–0.94). Discussion: More extensive STAS is an unfavourable prognostic factor in adenocarcinomas treated with sublobar resection. As the evaluation of extent of STAS is reproducible, further investigation is required to gather more evidence.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

The More Extensive the Spread through Air Spaces, the Worse the Prognosis Is: Semi-Quantitative Evaluation of Spread through Air Spaces in Pulmonary Adenocarcinomas

Zombori-Tóth¹,

Paróczai²,

Lantos

et al. 2022

Pathobiology

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“…Hence, most of the current clinical guidelines restricted the indications of segmentectomy for GGO‐dominant NSCLC or NSCLC with GGO components. Recent studies indicated that segmentectomy could reach a comparable outcome with lobectomy for small‐sized NSCLC, even for those with more malignant radiologic or pathological features, such as high metabolism, invasive characteristics, including lymphatic invasion, vascular invasion, pleural invasion, and/or lymph node metastasis, micropapillary, and solid subtypes, tumor spread through air space 2,16–19 . Generally, pure solid NSCLC was significantly correlated with these invasive features.…”

Section: Discussionmentioning

confidence: 99%

Segmentectomy versus lobectomy for small‐sized pure solid non–small cell lung cancer

Pan

et al. 2023

Thoracic Cancer

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Background: Segmentectomy has been recommended for ground glass opacity (GGO)-dominant small-sized non-small cell lung cancer (NSCLC) or those with GGO component. Pure solid NSCLC is a special sub-type and has an inferior prognosis. Whether segmentectomy could achieve comparable long-term outcomes with lobectomy for pure solid small-sized NSCLC remained controversial. This study aimed to compare the prognosis of segmentectomy and lobectomy for pure solid NSCLC. Methods: NSCLC patients with a pure solid nodule (≤2 cm) who received segmentectomy or lobectomy between January 2010 and June 2019 were retrospectively screened. Log-rank test, univariable, and multivariable Cox regression analyses were used for prognostic comparison. Further, the propensity score matching analysis was adopted to yield a matched cohort. Results: After screening, 344 pure solid NSCLC patients with a median follow-up time of 56 months were reserved. Among them, 98 patients underwent segmentectomy and the other 246 subjects received lobectomy. The lobectomy group had a larger tumor size, a higher rate of lymph node metastasis than the segmentectomy arm. Generally, patients with segmentectomy had a better disease-free survival (DFS) (p = 0.011) and overall survival (OS) (p = 0.028) than those with lobectomy. However, the multivariable Cox regression analysis indicated that no significant survival difference existed between segmentectomy and lobectomy after adjusting the potential confounding factors (DFS: hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.30-1.77, p = 0.476; OS: HR, 0.36; 95% CI, 0.08-1.59, p = 0.178). Consistently, in the propensity score matched cohort, segmentectomy (n = 74) yielded similar DFS (p = 0.960) and OS (p = 0.320) with lobectomy (n = 74). Conclusions: Segmentectomy could achieve comparable oncological outcomes with lobectomy for pure solid small-sized NSCLC.

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“…Sublobar resection was associated with worse outcomes than lobectomy in patients with T1 NSCLC with STAS [ 37 , 38 ]. Ikeda et al [ 39 ] recently published the results of a retrospective cohort study involving 555 patients ( n = 148 with STAS and n = 407 without STAS) with stage IA NSCLC. This cohort study evaluated recurrence-free survival (RFS) and overall survival (OS) with wedge resection, segmentectomy, and lobectomy for pathologic stage non-small cell lung cancer IA with spread through air spaces.…”

Section: Discussionmentioning

confidence: 99%

Lung Segmentectomy in NSCLC Surgery

Salvicchi

Tombelli

Mugnaini

et al. 2023

Life

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Current guidelines recommend surgery for early-stage non-small cell lung cancer (NSCLC). The standard treatment for patients with cT1N0 NSCLC has been lobectomy with lymph-node dissection, with sublobar resection used only in patients with inadequate cardio-respiratory reserve, with poor performance status, or who are elderly. In 1995, the Lung Cancer Study Group published the results of a randomized, prospective trial demonstrating the superiority of lobectomy compared with sublobar resection. From then on, wedge resection and segmentectomy were reserved exclusively for patients with poor functional reserve who could not tolerate lobectomy. Therefore, the exact role of segmentectomy has been controversial over the past 20 years. Recently, the randomized controlled trial JCOG0802/WJOG4607L demonstrated that segmentectomy was superior to lobectomy in patients with stage IA NSCLC (<2 cm and CTR < 0.5) in terms of both overall-survival and post-operative lung function. Based on these results, segmentectomy should be considered the standard surgical procedure for this patient group. In 2023, the randomized phase III CALGB 140503 (Alliance) trial demonstrated the efficacy and non-inferiority of sublobar resection, including wedge resection, for clinical stage IA NSCLC with tumor diameter of < 2 cm. This article is a narrative review of the current role of segmentectomy in lung cancer treatment and summarizes the most relevant studies in this context.

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Segmentectomy Provides Comparable Outcomes to Lobectomy for Stage IA Non-small Cell Lung Cancer with Spread through Air Spaces

Cited by 14 publications

References 28 publications

The More Extensive the Spread through Air Spaces, the Worse the Prognosis Is: Semi-Quantitative Evaluation of Spread through Air Spaces in Pulmonary Adenocarcinomas

The More Extensive the Spread through Air Spaces, the Worse the Prognosis Is: Semi-Quantitative Evaluation of Spread through Air Spaces in Pulmonary Adenocarcinomas

Segmentectomy versus lobectomy for small‐sized pure solid non–small cell lung cancer

Lung Segmentectomy in NSCLC Surgery

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