Long-Term Outcomes After Sublobar Resection Versus Lobectomy in Patients With Clinical Stage IA Lung Adenocarcinoma Meeting the Node-Negative Criteria Defined by High-Resolution Computed Tomography and [18F]-Fluoro-2-Deoxy-d-Glucose Positron Emission Tomography

Abstract

PurposeTo evaluate long-term outcomes after sublobar resection for patients with clinical stage IA lung adenocarcinoma who met our proposed node-negative (N0) criteria, namely solid component size < 0.8 cm on high-resolution computed tomography (HRCT) or a maximum standardized uptake value (SUVmax) of < 1.5 on [18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT). Patients and MethodsBetween April 2006 and December 2010, a total of 347 patients with clinical stage IA lung adenocarcinoma underwent complete resection in two medical centers. Long-term outcomes of patients with disease that met the N0 criteria after sublobar resection were evaluated. ResultsThe disease of 201 patients (57.9%) met the N0 criteria. Meeting N0 criteria was significantly associated with low-grade adenocarcinoma subtype (P < .001) and absence of lymphatic invasion (P < .001), vascular invasion (P < .001), and pleural invasion (P < .001). One patient (0.5%) had lymph node metastasis. The median follow-up period was 86.1 months. There was a significant difference in the overall survival (OS) rates between patients with disease that met the N0 criteria (5-year OS, 93.9%; 10-year OS, 90.3%) and disease that did not (5-year OS, 81.5%; 10-year OS, 64.3%; P < .001). Among patients with disease that met the N0 criteria, there was no significant difference in the OS between those who underwent lobectomy (5-year OS, 94.3%; 10-year OS, 92.6%) and those who underwent sublobar resection (5-year OS, 93.8%; 10-year OS, 89.3%; P = .64). ConclusionsSublobar resection of clinical stage IA lung adenocarcinoma is feasible in selected patients with disease that meets the N0 criteria, with excellent long-term survival.