Segmentectomy vs Lobectomy for Early Non-Small Cell Lung Cancer With Visceral Pleural Invasion

Mathey-Andrews, Camille; Abruzzo, Annie R.; Venkateswaran, Shivaek; Potter, Alexandra L.; Senthil, Priyanka; Beqari, Jorind; Yang, Chi‐Fu Jeffrey; Lanuti, Michael

doi:10.1016/j.athoracsur.2023.06.020

Cited by 9 publications

(2 citation statements)

References 11 publications

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“…However, certain studies have indicated that for stage IB NSCLC, the prognosis of sublobar resection is comparable to that of lobectomy. In cases where VPI is discovered after segmental resection in patients with stage I NSCLC, continuing with lobectomy is unlikely to yield additional survival benefits ( 63 , 64 ).…”

Section: Stage Ib and Surgical Approachmentioning

confidence: 99%

Diagnosis, treatment, and prognosis of stage IB non-small cell lung cancer with visceral pleural invasion

Ruan,

Zhuo,

2024

Front. Oncol.

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With the increasing implementation of early lung cancer screening and the increasing emphasis on physical examinations, the early-stage lung cancer detection rate continues to rise. Visceral pleural invasion (VPI), which denotes the tumor’s breach of the elastic layer or reaching the surface of the visceral pleura, stands as a pivotal factor that impacts the prognosis of patients with non-small cell lung cancer (NSCLC) and directly influences the pathological staging of early-stage cases. According to the latest 9th edition of the TNM staging system for NSCLC, even when the tumor diameter is less than 3 cm, the final T stage remains T2a if VPI is present. There is considerable controversy within the guidelines regarding treatment options for stage IB NSCLC, especially among patients exhibiting VPI. Moreover, the precise determination of VPI is important in guiding treatment selection and prognostic evaluation in individuals with NSCLC. This article aims to provide a comprehensive review of the current status and advancements in studies pertaining to stage IB NSCLC accompanied by VPI.

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Section: Stage Ib and Surgical Approachmentioning

confidence: 99%

Diagnosis, treatment, and prognosis of stage IB non-small cell lung cancer with visceral pleural invasion

Ruan,

Zhuo,

2024

Front. Oncol.

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“…Furthermore, in the cohort of tumors 1 to 2 cm, VPI was present in only 52 of 9750 patients, or roughly 1% of all patients with the descriptor. The uncertainty about the prognostic relevance of VPI in these small tumors has led some to argue that intraoperative suspicion of VPI should prompt lobar resection and others to posit that recurrence and survival are similar regardless of the extent of resection . This controversy is informed almost exclusively by retrospective data generated from large case series or registry data rather than from the results of randomized clinical trials.…”

Section: Introductionmentioning

confidence: 99%

Recurrence of Non–Small Cell Lung Cancer With Visceral Pleural Invasion

Altorki,

Wang,

Damman

et al. 2024

JAMA Oncol

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ImportanceThe randomized clinical trial Cancer and Leukemia Group B (CALGB) 140503 showed that for patients with clinically staged T1N0 non–small cell lung cancer (NSCLC; ≤2 cm), sublobar resections were associated with similar oncological outcomes to those after lobar resection. The association of the extent of parenchymal resection with recurrence and survival in patients with tumors pathologically upstaged to T2 based on visceral pleural invasion (VPI) is controversial.ObjectiveTo determine survival and recurrence rates in patients with small peripheral pT2 NSCLC (≤2 cm) that was treated by either lobar or sublobar resection in CALGB 140503.Design, Participants, and SettingCALGB 140503, a randomized multicenter noninferiority trial, included 697 patients with small peripheral NSCLC that was clinically staged as T1N0. Enrollment was from June 2007 through March 2017 at 83 participating institutions, and after a median follow-up of 7 years, the primary outcome of disease-free survival after sublobar resection was noninferior to that after lobar resection.InterventionLobar or sublobar resection.Main Outcomes and MeasuresSurvival end points were estimated by the Kaplan-Meier estimator. Hazard ratios and 95% CIs were estimated using stratified Cox proportional hazard models.ResultsOf 679 participants, 390 (57.4%) were female, and the median (range) age was 67.8 (37.8-89.7) years. Among 697 patients randomized, 566 (81.2%) had pT1 tumors (no VPI) and 113 (16.2%) had pT2 tumors (VPI). Five-year disease-free survival was 65.9% (95% CI, 61.9%-70.2%) in patients with pT1 compared with 53.3% (95% CI, 44.3%-64.1%) in patients with pT2 tumors (stratified log-rank: P = .02). Disease recurrence developed in 27.6% of patients with pT1 (locoregional only: 60 [10.8%]; distant only: 81 [14.6%]) and 41.6% of those with pT2 (locoregional only: 17 [15.0%]; distant only: 27 [23.9%]). Five-year recurrence-free survival was 73.1% (95% CI, 69.2%-77.1%) for pT1 tumors and 58.2% (95% CI, 49.2%-68.8%) for pT2 tumors (stratified log-rank: P = .01). There were no intergroup differences in disease-free or recurrence-free survival based on the extent of parenchymal resection.Conclusions and RelevanceThe results of this secondary analysis suggest that compared with patients with tumors without VPI, patients who had tumors with VPI had worse disease-free and recurrence-free survival and a higher rate of local and distant disease recurrence. These high rates of recurrence were independent of the extent of parenchymal resection, and these data support the inclusion of these patients in adjuvant therapy trials.Trial RegistrationClinicalTrials.gov Identifier: NCT0049933

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Can radiologists confidently diagnose visceral pleural invasion in small-sized lung cancer?

Arenas-Jiménez

2023

Eur Radiol

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Segmentectomy vs Lobectomy for Early Non-Small Cell Lung Cancer With Visceral Pleural Invasion

Cited by 9 publications

References 11 publications

Diagnosis, treatment, and prognosis of stage IB non-small cell lung cancer with visceral pleural invasion

Diagnosis, treatment, and prognosis of stage IB non-small cell lung cancer with visceral pleural invasion

Recurrence of Non–Small Cell Lung Cancer With Visceral Pleural Invasion

Can radiologists confidently diagnose visceral pleural invasion in small-sized lung cancer?

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