Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial

Saji, Hisashi; Okada, Minoru; Tsuboi, Masahiro; Nakajima, Ryu; Suzuki, Kenji; Aokage, Keiju; Aoki, Tadashi; Okami, Jiro; Yoshino, Ichiro; Ito, Hiroyuki; Okumura, Norihito; Yamaguchi, Masafumi; Ikeda, Norihiko; Wakabayashi, Masashi; Nakamura, Kenichi; Fukuda, Haruhiko; Nakamura, Shinichiro; Mitsudomi, Tetsuya; Watanabe, Shun‐ichi; Asamura, Hisao

doi:10.1016/s0140-6736(21)02333-3

Cited by 872 publications

(654 citation statements)

References 16 publications

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“…Its latest follow-up results showed that the 5-year OS rate of segmentectomy was not worse than that of lobectomy in tumor size ≤2 cm NSCLC patients (94.3% vs. 91.1%; HR: 0.663, 95% CI: 0.474-0.927; one-sided P<0.0001 for non-inferiority; P=0.0082 for superiority), and the 5-year relapse-free survival had no significant difference (88.0% vs. 87.9%; HR: 0.998, 95% CI: 0.753-1.323; P=0.9889). In addition, segmentectomy had a better protective effect on lung function (24). However, some scholars raised objections (25)(26)(27).…”

Section: Discussionmentioning

confidence: 99%

Surgical Options for Resectable Lung Adenosquamous Carcinoma: A Propensity Score-Matched Analysis

Zhu

Xiong

et al. 2022

Front. Oncol.

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BackgroundSurgery is the primary treatment option for Lung adenosquamous carcinoma (ASC) patients. However, no study compares the benefits of lobectomy and sublobar resection in ASC patients.MethodsA total of 1379 patients in the Surveillance, epidemiology, and End Results (SEER) database and 466 patients in Shanghai Pulmonary Hospital (SPH) were enrolled. Survival benefits were evaluated after possible confounders were eliminated by propensity score matching (PSM).ResultsAfter 1:3 PSM, 463 SEER database patients and 244 SPH patients were enrolled. Lobectomy was associated with better overall survival (OS) and disease-free survival (DFS) than sublobar resection for ASC patients (5-year OS of SEER: 46.9% vs. 33.3%, P =0.017; 5-year OS of SPH: 35.0% vs. 16.4%, P =0.002; 5-year DFS of SPH: 29.5% vs. 14.8%, P =0.002). Similar results were observed in stage I patients. Univariate and multivariate Cox regression analyses showed that sublobar resection was an adverse prognostic factor independently (SEER: HR: 1.40, 95%CI: 1.08-1.81, P =0.012; SPH: HR: 1.73, 95%CI: 1.11-2.70, P =0.015). Subgroup analysis showed that all of the ASC patient subtypes tended to benefit more from lobectomy than sublobar resection.ConclusionsLobectomy remains the primary option for ASC patients compared to sublobar resection, including stage I.

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Section: Discussionmentioning

confidence: 99%

Surgical Options for Resectable Lung Adenosquamous Carcinoma: A Propensity Score-Matched Analysis

Zhu

Xiong

et al. 2022

Front. Oncol.

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“…Compared with lobectomy, the main advantages of sublobar resection are the reduction of perioperative morbidity and the preservation of postoperative pulmonary function [3,4]. Recent retrospective studies have demonstrated that survival is similar after both sublobar resection and lobectomy [5][6][7][8]. Meanwhile, with the increased detection of small tumors and the association between the appearance of ground-glass opacity and a good histological type, the use of sublobar resection has increased [9].…”

Section: Introductionmentioning

confidence: 99%

Lobe-Specific Analysis of Sublobar Lung Resection for NSCLC Patients with Tumors ≤ 2 cm

Lei

Zhou

Zhang

et al. 2022

Cancers

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(1) Background: Sublobar resection can be used as an alternative surgical strategy for early-stage non-small-cell lung cancer (NSCLC) patients. However, the choice between wedge resection and segmentectomy remains contentious. In this study, we investigated the optimal surgical procedure for sublobar resection in patients with NSCLC ≤ 2 cm with a lobe-specific analysis; (2) Methods: Data for patients with T1N0M0 with a diameter of ≤2 cm who had undergone sublobar resection were retrieved. Propensity score matching (PSM) was used to reduce the inherent bias, and the Kaplan–Meier method and log-rank tests were used to assess the differences in survival; (3) Results: A total of 1882 patients were identified after the PSM. Patients with NSCLC ≤ 2 cm who had undergone segmentectomy showed better survival than those who had undergone wedge resection. However, when NSCLC was ≤1 cm, there was no significant difference in OS between the two groups. This demonstrated an OS advantage of segmentectomy over wedge resection for patients with NSCLC tumors of 1–2 cm (p = 0.024). Further analysis indicated that this survival benefit was only observed in patients with right upper NSCLC of 1–2 cm, but not with NSCLC in the other four lobes; (4) Conclusions: Segmentectomy showed a greater survival benefit than wedge resection only in patients with NSCLC of 1–2 cm, particularly those with primary tumors in the right upper lobe. Therefore, we propose a lobe-specific sublobar resection strategy for early-stage NSCLC patients (tumors of 1–2 cm) who cannot tolerate lobectomy.

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“…In previous investigations, CT volumetric analysis was found to be more accurate than ASC in predicting PPO-FEV1 and PPO-DLCO after lobectomy, bilobectomy and pneumonectomy [ 4 , 5 ]. Because segmentectomy’s long-term oncologic prognosis in early-stage lung cancer was found to be comparable to that of lobectomy, segmentectomy has lately been advocated as an alternative surgical approach for treating early-stage lung cancer [ 6 ]. Despite the fact that segmentectomy is one of the most commonly used surgical procedures, there has been no research on a valid approach for calculating PPO-FEV1 and PPO-DLCO in segmentectomy.…”

Section: Introductionmentioning

confidence: 99%

Computed tomography volumetric analysis for predicting postoperative lung function for segmentectomy

Bae

Lee

et al. 2022

Interactive CardioVascular and Thoracic Surgery

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Objectives We compared the computed tomographic (CT) volumetric analysis and anatomical segmental counting (ASC) for predicting postoperative forced expiratory volume in 1 second (FEV1) and diffusing capacity for carbon monoxide (DLCO) in patients who had segmentectomy for early-stage lung cancer. Methods A total of 175 patients who had segmentectomy for lung cancer and had postoperative pulmonary function test (PFT) were included. CT volumetric analysis was performed by software which could measure total lung and target segment volume from CT images. ASC and CT volumetric analysis were used to determine predicted postoperative (PPO) values and the concordance and difference of these values were assessed. The relationship between PPO values and actual postoperative values was also investigated. Results The PPO-FEV1 and PPO-DLCO showed high concordance between two methods (concordance correlation coefficient = 0.96 for PPO-FEV1 and 0.95 for PPO-DLCO). There was no significant difference between PPO values as determined by two methods (p = 0.53 for PPO-FEV1, p = 0.25 for PPO-DLCO) and actual postoperative values (p = 0.77 (ASC vs actual) and p = 0.20 (CT vs actual) for FEV1; p = 0.41 (ASC vs actual) and p = 0.80 (CT vs actual) for DLCO). We subdivided the patients according to poor PFT, the number of resected segments and location of resected lobe. All subgroup analysis revealed no significant difference between PPO values and actual postoperative values. Conclusions Both CT volumetric analysis and ASC showed high predictability for actual postoperative FEV1 and DLCO in segmentectomy.

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Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial

Cited by 872 publications

References 16 publications

Surgical Options for Resectable Lung Adenosquamous Carcinoma: A Propensity Score-Matched Analysis

Surgical Options for Resectable Lung Adenosquamous Carcinoma: A Propensity Score-Matched Analysis

Lobe-Specific Analysis of Sublobar Lung Resection for NSCLC Patients with Tumors ≤ 2 cm

Computed tomography volumetric analysis for predicting postoperative lung function for segmentectomy

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