Extent of surgical resection for radiologically subsolid T1N0 invasive lung adenocarcinoma: When is a wedge resection acceptable?

Abstract

ObjectiveTo evaluate whether wedge resection (WR) was appropriate for the patients with peripheral T1 N0 solitary subsolid invasive lung adenocarcinoma. MethodsPatients with peripheral T1N0 solitary subsolid invasive lung adenocarcinoma who received sublobar resection were retrospectively reviewed. Clinicopathologic characteristics, 5-year recurrence-free survival, and 5-year lung cancer-specific overall survival were analyzed. Cox regression model was used to elucidate risk factors for recurrence. ResultsTwo hundred fifty-eight patients receiving WR and 1245 patients receiving segmentectomy were included. The mean follow-up time was 36.87 ± 16.21 months. Five-year recurrence-free survival following WR was 96.89% for patients with ground-glass nodule (GGN) ≤2 cm and 0.25< consolidation-to-tumor ratio (CTR) ≤0.5, not statistically different from 100% for those with GGN≤2 cm and CTR ≤0.25 (P = .231). The 5-year recurrence-free survival was 90.12% for patients with GGN between 2 and 3 cm and CTR ≤0.5, significantly lower than that of patients with GGN ≤2 cm and CTR ≤0.25 (P = .046). For patients with GGN≤2 cm and 0.25<CTR≤0.5, 5-year recurrence-free survival and lung cancer-specific overall survival were 97.87% and 100% following WR versus 97.73% and 92.86% following segmentectomy (recurrence-free survival: P = .987; lung cancer-specific overall survival: P = .199), respectively. For patients with GGN between 2 and 3 cm and CTR ≤0.5, 5-year recurrence-free survival following WR was significantly lower than that following SEG (90.61% vs 100%; P = .043). Multi-variable Cox regression analysis showed that spread through airspace, visceral pleural invasion, and nerve invasion remained independent risk factors for recurrence of patients with GGN between 2 and 3 cm and CTR ≤0.5 following WR. ConclusionsWR might be appropriate for patients with invasive lung adenocarcinoma appearing as peripheral GGN ≤2 cm and CTR ≤0.5, but inappropriate for those with invasive lung adenocarcinoma appearing as peripheral GGN between 2 and 3 cm and CTR ≤0.5.