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. 2019 Jun;11(6):2361-2372.
doi: 10.21037/jtd.2019.05.79.

Prognosis after wedge resection in patients with 8th edition TNM stage IA1 and IA2 non-small cell lung cancer

Youngkyu Moon  1 , Jae Kil Park  1 , Kyo Young Lee  2 , Eun Sung Kim  3
Affiliations

Prognosis after wedge resection in patients with 8th edition TNM stage IA1 and IA2 non-small cell lung cancer

Youngkyu Moon et al. J Thorac Dis. 2019 Jun.

Abstract

Background: According to the 8th edition TNM classification for non-small cell lung cancer (NSCLC), tumor stage (T) is determined by the maximum size of the invasive component, without the lepidic component, and the T category has been further subdivided. We investigated the indications for wedge resection using the 8th edition TNM staging system, which measures only the size of the invasive component in tumor size.

Methods: We compared 5-year disease-free survival (DFS) rates in 429 consecutive patients with 8th edition stage IA1 and IA2 NSCLC who underwent lobectomy or wedge resection from 2007 to 2017. We also analyzed the risk factors for recurrence after surgical resection.

Results: There were no significant differences in clinicopathological factors or 5-year DFS in patients with stage IA1 disease (5-year DFS 95.0%, lobectomy, vs. 91.6%, wedge resection; P=0.435). For patients with stage IA2 tumors, the 5-year DFS was 88.3% after lobectomy and 74.0% after wedge resection (P=0.118). There were significant differences in clinicopathological characteristics between lobectomy and wedge resection groups in stage IA2 NSCLC. On multivariate analysis, serum CEA level [hazard ratio (HR) =1.040, P=0.046] and lymphovascular invasion (HR =2.664, P=0.027), but not wedge resection, were significant risk factors for recurrence in stage IA2 NSCLC. On multivariate analysis for recurrence risk after wedge resection in stage IA1 and stage IA2 NSCLC, only the width of the resection margin was associated with recurrence.

Conclusions: Wedge resection may be an acceptable procedure in stage IA1 NSCLC. When performing wedge resection, it is necessary to ensure a sufficient resection margin distance.

Keywords: 8th edition TNM classification; Wedge resection; prognosis.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Study inclusion/exclusion algorithm.
Figure 2
Figure 2
Disease-free survival after lobectomy versus wedge resection in stage IA1 non-small cell lung cancer.
Figure 3
Figure 3
Disease-free survival after lobectomy versus wedge resection in stage IA2 non-small cell lung cancer.
See this image and copyright information in PMC

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