The Role of Extent of Surgical Resection and Lymph Node Assessment for Clinical Stage I Pulmonary Lepidic Adenocarcinoma: An Analysis of 1991 Patients

Abstract

Background This study examined the association of extent of lung resection, pathologic nodal evaluation, and survival for patients with clinical stage I (cT1-2N0M0) adenocarcinoma with lepidic histology in the National Cancer Database (NCDB). Methods The association between extent of surgical resection and long-term survival for patients in the NCDB with clinical stage I lepidic adenocarcinoma who underwent lobectomy or sublobar resection was evaluated using Kaplan-Meier and Cox proportional hazards regression analyses. Results Of the 1,991 patients with cT1-2N0M0 lepidic adenocarcinoma who met study criteria, 1,544 patients underwent lobectomy and 447 underwent sublobar resections. Patients treated with sublobar resection were older, more likely to be female, had higher Charlson/Deyo comorbidity scores, but had smaller tumors and lower T-status. Of patients treated with lobectomy, 6% (n=92) were upstaged due to positive nodal disease, with a median of 7 lymph nodes sampled (IQR: 4,10). In an analysis of the entire cohort, lobectomy was associated with a significant survival advantage over sublobar resection in univariate analysis (median survival 9.2 vs. 7.5 years, p=0.022; 5-year survival 70.5% vs. 67.8%) and following multivariable adjustment (hazard ratio [HR]: 0.81 [95% [CI]: 0.68–0.95], p=0.011), (Figure 1). However, lobectomy was no longer independently associated with improved survival when compared to sublobar resection (HR: 0.99 [95% CI: 0.77–1.27], p= 0.905) in a multivariable analysis of a subset of patients that compared only those patients who underwent sublobar resection that included lymph node sampling to patients treated with lobectomy. Conclusions Surgeons treating patients with stage I lung adenocarcinoma with lepidic features should cautiously utilize sublobar resection rather than lobectomy and must always perform adequate pathologic lymph node evaluation.

Strategies of Lymph Node Dissection During Sublobar Resection for Early-Stage Lung Cancer

“…Cox et al showed that in a series of 1991 lipid adenocarcinomas that had either lobectomy or segmentectomy, survival was significantly better after lobectomy, except in the subgroup of SLRs associated with lymph node dissection. The authors concluded that lymph node dissection was essential during segmentectomy ( 35 ). These conclusions are in line with those of Wolf et al and Matioli et al in earlier publications ( 36 , 37 ): segmentectomies have a survival equivalent to that of lobectomies only when lymph node dissection is performed.…”

Oncologic outcomes of segmentectomy vs lobectomy in pathologic stage IA (≤2 cm) invasive lung adenocarcinoma: A population‐based study

“…Therefore, the conclusions cannot be extrapolated to patients with longer life expectancies. Cox et al 32 examined the association of the extent of lung resection and survival in 1991 patients with IAC and found that limited resection could achieve survival similar to that of lobectomy as long as lymph nodes were examined. However, this study only included patients with lepidic predominant adenocarcinoma and the segmentectomy cohort was too small for subgroup analysis.…”

Bronchioalveolar carcinoma in an adult alpaca (Vicugna pacos)

“…In humans, the prognosis after treatment by surgical resection, chemotherapy, radiation therapy or combinations is better than in other types. No specific risk factors for this type of lung neoplasia are known [8, 10]. In the described case, no history of a previous lung affection was reported.…”