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General Thoracic and Cardiovascular Surgery
Published in: General Thoracic and Cardiovascular Surgery 8/2019

01-08-2019 | NSCLC | Original Article

Optimal sublobar resection for c-stage I non-small cell lung cancer: significance of margin distance to tumor size ratio and margin cytology (Supplementary analysis of KLSG-0801): complete republication

Authors: Nobumasa Takahashi, Noriyoshi Sawabata, Masafumi Kawamura, Takashi Ohtsuka, Hirotoshi Horio, Hirozo Sakaguchi, Mitsuo Nakayama, Katsuo Yoshiya, Masayuki Chida, Eishin Hoshi, All the co-authors are members of Kan-Etsu Lung Cancer Study Group (KLSG)

Published in: General Thoracic and Cardiovascular Surgery | Issue 8/2019

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Abstract

Background

Sublobar resection for lung cancer is associated with a higher risk of recurrence than that of lobectomy; we evaluated the factors considered to be predictors of recurrence.

Methods

By analyzing multicenter prospective studies of sublobar resection for patients with c-stage I non-small lung cancer who were unable to undergo lobectomy (KLSG-0801), we investigated the relationship between (1) tumor location (TL) and margin distance from the stump (MD), (2) the MD/tumor size (TS) ratio and prognosis, (3) and the margin cytology (MC) and prognosis.

Results

The correlation between TS and MD was statistically significant in cases of easily resectable regions defined by Lewis’ classification (n = 18). However, there was no correlation in difficult-to-resect regions (n = 14). Among cases of recurrence, the MD/TS ratio was less than 1. The 3-year survival rate was 100% for patients with MD/TS > 1 (n = 12), 59.7% for patients with MD/TS ≤ 1 (n = 20) (p = 0.06), 88.1% in cases of negative MC (n = 18), and 20% in cases of positive MC (n = 5) (p = 0.001).

Conclusion

Cases with positive MC had a significantly worse prognosis than those with negative MC. It may be difficult to secure an MD greater than the TS in a difficult-to-resect region according to Lewis’ classification.
Literature
1.
Masuda M, Kuwano H, Okumura M, Amano J, Arai H. Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, et al. Thoracic and cardiovascular surgery in Japan during 2012: annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2014; 62:734–64.CrossRefPubMedPubMedCentral
2.
Takahashi N, Sawabata N, Kawamura M, Ohtsuka T, Horio H, Sakaguchi H, et al. Multicenter prospective study of sublober resection for c-Stage I Non-small cell lung cancer among patients with little physical preservation for lobectomy. (KLSG-0801). Jpn J Chest Surg. 2016;30:526–33.CrossRef
3.
Takahashi N, Sawabata N, Kawamura M, Ohtsuka T, Horio H, Sakaguchi H,et al. Multicenter prospective study of sublobar resection for c-stage I non-small cell lung cancer patients unable to undergo lobectomy (KLSG-0801): complete republication. Gen Thorac Cardiovasc Surg. 2016;64:470–5.CrossRefPubMed
4.
Lewis RJ, Caccavale RJ, Sisler GE, Mackenzie JW. Video-assisted thoracic surgical resection of malignant lung tumors. J Thorac Cardiovasc Surg. 1992;104:1679–85.PubMed
5.
Goldstein NS, Ferkowicz M, Kestin L, Chmielewski GW, Welsh RJ. Wedge resection margin distances and residual adenocarcinoma in lobectomy specimens. Am J Clin Pathol. 2003;120:720–4.CrossRefPubMed
6.
Sawabata N. Locoregional recurrence after pulmonary sublobar resection of non-small cell lung cancer: can it be reduced by considering cancer cells at the surgical margin? Gen Thorac Cardiovasc Surg. 2013;61:9–16.CrossRefPubMed
7.
El-Sherif A, Gooding WE, Santos R, Pettiford B, Ferson PF, Fernando HC, et al. Outcomes of sublobar resection versus lobectomy for stage I non-small cell lung cancer: a 13-year analysis. Ann Thorac Surg. 2006;82:408–15.CrossRefPubMed
8.
Landreneau RJ, Sugarbaker DJ, Mack MJ, Hazelrigg SR, Luketich JD, Fetterman L, et al. Wedge resection versus lobectomy for stage I (T1 N0 M0) non-small cell lung cancer. J Thorac Cardiovasc Surg. 1997;113:691–700.CrossRefPubMed
9.
Errett LE, Wilson J, Chiu RC, Munro DD. Wedge resection as an alternative procedure for peripheral bronchogenic carcinoma in poor-risk patients. J Thorac Cardiovasc Surg. 1985;90:656–61.PubMed
10.
Strauss G, Kwiatkoski D, De-Camp M, Godleski J, Swanson S, Richards W, et al. Extent of surgical resection influences survival in stage IA non-small cell lung cancer (NSCLC). Proc ASCO. 1998;17:462a.
11.
Miller JI, Hatcher CR Jr. Limited resection of bronchogenic carcinoma in the patient with marked impairment of pulmonary function. Ann Thorac Surg. 1987;44:340–3.CrossRefPubMed
12.
13.
Pastorino U, Valente M, Bedini V, Infante M, Tavecchio L, Ravasi G. Limited resection for stage I lung cancer. Eur J Surg Oncol. 1991;17:42–6.PubMed
14.
Onishi H, Araki T. Stereotactic body radiation therapy for stage I non-small-cell lung cancer: a historical overview of clinical studies. Jpn J Clin Oncol. 2013;43:345–50.CrossRefPubMed
15.
Nagata Y, Hiraoka M, Shibata T, Onishi H, Kokubo M, Karasawa K, et al. Prospective trial of stereotactic body radiation therapy for both operable and inoperable T1N0M0 Non-small cell lung cancer: Japan Clinical Oncology Group Study JCOG0403. Int J Radiat Oncol Biol Phys. 2015;93:989–96.CrossRefPubMed
16.
Timmerman R, McGarry R, Yiannoutsos C, Papiez L, Tudor K, DeLuca J, et al. Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer. J Clin Oncol. 2006;24:4833–9.CrossRefPubMed
17.
Sawabata N, Karube Y, Umezu H, Tamura M, Seki N, Ishihama H, et al. Cytologically malignant margin without continuous pulmonary tumor lesion: cases of wedge resection, segmentectomy and lobectomy. Interact Cardiovasc Thorac Surg. 2008;7:1044–8.CrossRefPubMed
18.
Sawabata N, Ohta M, Matsumura A, Nakagawa K, Hirano H, Maeda H, et al. Thoracic Surgery Study Group of Osaka University. Optimal distance of malignant negative margin in excision of nonsmall cell lung cancer: a multicenter prospective study. Ann Thorac Surg. 2004;77:415–20.CrossRefPubMed
19.
Mohiuddin K, Haneuse S, Sofer T, Gill R, Jaklitsch MT, Colson YL, et al. Relationship between margin distance and local recurrence among patients undergoing wedge resection for small (≤ 2 cm) non–small cell lung cancer. J Thorac Cardiovasc Surg. 2014;147:1169–77.CrossRefPubMed
20.
Sawabata N, Maeda H, Matsumura A, Ohta M, Okumura M, Thoracic Surgery Study Group of Osaka University. Clinical implications of the margin cytology findings and margin/tumor size ratio in patients who underwent pulmonary excision for peripheral non-small cell lung cancer. Surg Today. 2012;42:238–44.CrossRefPubMed
21.
22.
Metadata
Title
Optimal sublobar resection for c-stage I non-small cell lung cancer: significance of margin distance to tumor size ratio and margin cytology (Supplementary analysis of KLSG-0801): complete republication
Authors
Nobumasa Takahashi
Noriyoshi Sawabata
Masafumi Kawamura
Takashi Ohtsuka
Hirotoshi Horio
Hirozo Sakaguchi
Mitsuo Nakayama
Katsuo Yoshiya
Masayuki Chida
Eishin Hoshi
All the co-authors are members of Kan-Etsu Lung Cancer Study Group (KLSG)
Publication date
01-08-2019
Publisher
Springer Singapore
Keywords
NSCLC
NSCLC
Published in
General Thoracic and Cardiovascular Surgery / Issue 8/2019
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-019-01069-8

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