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. 2024 Nov 30;16(11):7511-7525.
doi: 10.21037/jtd-24-783. Epub 2024 Nov 22.

Loco-regional relapse pattern and timing after segmentectomy in patients with c-IA non-small cell lung cancer

Hironobu Wada  1   2 , Hidemi Suzuki  1 , Takahide Toyoda  1 , Yuki Sata  1 , Terunaga Inage  1 , Kazuhisa Tanaka  1 , Yuichi Sakairi  1 , Yukiko Matsui  1 , Shigetoshi Yoshida  2 , Ichiro Yoshino  1   2
Affiliations

Loco-regional relapse pattern and timing after segmentectomy in patients with c-IA non-small cell lung cancer

Hironobu Wada et al. J Thorac Dis. .

Abstract

Background: Segmentectomy has been recognized as the standard procedure for small peripheral lung cancer; however, it has been shown that loco-regional relapse is more common with segmentectomy than with lobectomy. This study aims to investigate the long-term outcomes and loco-regional relapse patterns in patients with clinical stage IA (c-IA) non-small cell lung cancer (NSCLC) after segmentectomy and compare them with those after lobectomy.

Methods: We retrospectively compared the long-term outcomes of 115 patients who underwent segmentectomy for c-IA NSCLC with those of 292 patients who underwent lobectomy between January 2008 and December 2015. Segmentectomy was indicated intentionally or chosen in patients who were considered intolerable to lobectomy. New isolated growing lung lesions were defined as relapses if they were not diagnosed with a second primary lung cancer.

Results: The median observation period was 2,150 days. The 10-year overall survival (OS) rates and relapse-free survival (RFS) rates of the two groups were similar: 79.4% and 68.7% for segmentectomy, and 68.2% and 61.2% for lobectomy. Even after propensity score matching, no significant differences were observed in the OS and RFS rates between the groups. The segmentectomy group had a higher loco-regional relapse rate (14% vs. 8%), including the surgical margin, remnant lobe, ipsilateral lung, mediastinal lymph node, and ipsilateral dissemination; however, no relapse was observed in the ipsilateral hilar lymph node. Loco-regional relapse occurred significantly later after segmentectomy than after lobectomy (median: 1,246 vs. 512 days, P=0.03), especially four years after segmentectomy. Loco-regional relapse occurred even when the tumor diameter was <1.0 cm. Most patients with loco-regional relapse had solid-dominant tumors.

Conclusions: Segmentectomy, both intentional and compromised, showed comparable long-term outcomes to lobectomy; however, loco-regional relapse can develop in a later phase than lobectomy, requiring careful follow-up.

Keywords: Non-small cell lung cancer (NSCLC); lobectomy; loco-regional relapse; segmentectomy.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-783/coif). I.Y. reported consulting fees from Medicaroid, Covidien, Johnson and Johnson, and payment or honoraria for lectures, presentations from Covidien, Johnson and Johnson, Intuitive Surgical, Astra Zeneca, Chugai Pharmaceutical, Taiho Pharmaceutical, and MSD. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
The flow chart of the patients included in this study. c-IA, clinical stage IA; NSCLC, non-small cell lung cancer.
Figure 2
Figure 2
The long-term outcomes after segmentectomy and lobectomy. The overall (A) and relapse-free (B) survival after segmentectomy and lobectomy. The overall (C) and relapse-free (D) survival among three groups, including intentional, compromised segmentectomy, and lobectomy. OS, overall survival; RFS, relapse-free survival; Seg, segmentectomy; Lob, lobectomy.
Figure 3
Figure 3
The overall survival (A) and relapse-free survival (B) after segmentectomy and lobectomy using propensity score-matched analysis. OS, overall survival; RFS, relapse-free survival; Seg, segmentectomy; Lob, lobectomy.
Figure 4
Figure 4
The cumulative incidence of loco-regional relapse (A) and distant relapse (B) after segmentectomy and lobectomy. CILR, cumulative incidence of loco-regional relapse; CI, confidence interval; Seg, segmentectomy; Lob, lobectomy; CIDR, cumulative incidence of distant relapse.
See this image and copyright information in PMC

References

    1. Saji H, Okada M, Tsuboi M, et al. 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. Lancet 2022;399:1607-17. 10.1016/S0140-6736(21)02333-3 - DOI - PubMed
    1. Altorki N, Wang X, Kozono D, et al. Lobar or Sublobar Resection for Peripheral Stage IA Non-Small-Cell Lung Cancer. N Engl J Med 2023;388:489-98. 10.1056/NEJMoa2212083 - DOI - PMC - PubMed
    1. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg 1995;60:615-22; discussion 622-3. 10.1016/0003-4975(95)00537-U - DOI - PubMed
    1. Suzuki K, Koike T, Asakawa T, et al. A prospective radiological study of thin-section computed tomography to predict pathological noninvasiveness in peripheral clinical IA lung cancer (Japan Clinical Oncology Group 0201). J Thorac Oncol 2011;6:751-6. 10.1097/JTO.0b013e31821038ab - DOI - PubMed
    1. Asamura H, Hishida T, Suzuki K, et al. Radiographically determined noninvasive adenocarcinoma of the lung: survival outcomes of Japan Clinical Oncology Group 0201. J Thorac Cardiovasc Surg 2013;146:24-30. 10.1016/j.jtcvs.2012.12.047 - DOI - PubMed

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