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Abstract

We are grateful for the letter by Baisi and colleagues [1Baisi A. Raveglia F. De Simone M. Cioffi U. Do tumor size and carcinoembryonic antigen level affect surgical management of partially solid early-stage lung cancer? (letter).Ann Thorac Surg. 2017; 103: 1036Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar] regarding our recent study [2Hattori A. Matsunaga T. Takamochi K. Oh S. Suzuki K. Neither maximum tumor size nor solid component size is prognostic in part-solid lung cancer: impact of tumor size should be applied exclusively to solid lung cancer.Ann Thorac Surg. 2016; 102: 407-415Abstract Full Text Full Text PDF PubMed Scopus (88) Google Scholar] that was submitted to The Annals of Thoracic Surgery. In our article, we elucidated that the effect of maximum tumor size was exclusive to patients with radiologic pure-solid tumor without a ground glass opacity (GGO) component, whereas neither maximum tumor size nor solid component size were prognostic in patients with part-solid tumor [2Hattori A. Matsunaga T. Takamochi K. Oh S. Suzuki K. Neither maximum tumor size nor solid component size is prognostic in part-solid lung cancer: impact of tumor size should be applied exclusively to solid lung cancer.Ann Thorac Surg. 2016; 102: 407-415Abstract Full Text Full Text PDF PubMed Scopus (88) Google Scholar]. Hence, a thorough distinction is important based on the presence of a GGO component when considering the clinicopathologic characteristics or oncologic outcomes of clinically node-negative early-stage lung cancers. These results could be of great significance to the clinical T staging system. The presence of a GGO component per se could strongly affect the prognosis, and it should be added as an important clinical T descriptor. Our suggestions would likely be assessed thoroughly when revising or improving the next edition of the T component of the TNM classification for lung cancer. Our findings could also influence decisions regarding the appropriate operative modes for small-sized lung cancer in the future. Currently, the efficacy of sublobar resection is being prospectively evaluated for c-T1a radiologically part-solid or pure-solid tumor (0.5 ≤ consolidation tumor ratio [CTR] ≤ 1.0) in Japan (Japan Clinical Oncology Group 0802 study). In our recent article [2Hattori A. Matsunaga T. Takamochi K. Oh S. Suzuki K. Neither maximum tumor size nor solid component size is prognostic in part-solid lung cancer: impact of tumor size should be applied exclusively to solid lung cancer.Ann Thorac Surg. 2016; 102: 407-415Abstract Full Text Full Text PDF PubMed Scopus (88) Google Scholar], we retrospectively compared the prognostic effect of operative modes based on the presence of GGO. As a result, segmentectomy and lobectomy with hilar or mediastinal lymph node dissection had similar oncologic outcomes regarding locoregional recurrences in patients with clinical-T1a radiologic part-solid tumor (i.e., 0.5 ≤ CTR < 1.0) [3Hattori A, Matsunaga T, Takamochi K, Oh S, Suzuki K. Locoregional recurrence after segmentectomy for clinical-T1aN0M0 radiologically solid non-small cell lung carcinoma. Eur J Cardiothorac Surg. In press.Google Scholar]. However, it is certain that locoregional recurrence-free survival of segmentectomy was significantly worse than that of lobectomy when the tumor showed a radiologically pure-solid appearance (CTR = 1.0) [3Hattori A, Matsunaga T, Takamochi K, Oh S, Suzuki K. Locoregional recurrence after segmentectomy for clinical-T1aN0M0 radiologically solid non-small cell lung carcinoma. Eur J Cardiothorac Surg. In press.Google Scholar]. Therefore, segmentectomy should be applied with great caution for radiologically pure-solid tumors because of their highly invasive nature. As noted by Baisi and colleagues [1Baisi A. Raveglia F. De Simone M. Cioffi U. Do tumor size and carcinoembryonic antigen level affect surgical management of partially solid early-stage lung cancer? (letter).Ann Thorac Surg. 2017; 103: 1036Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar], regarding the selection of appropriate operative modes in patients with part-solid adenocarcinoma, accurate prediction of nodal involvement or pathological invasiveness is warranted using carcinoembryonic antigen or maximum standardized uptake value on positron emission tomography for the possible indication of sublobar resection. Appropriate indication of sublobar resection for small-sized lung cancers is still controversial for a recent general thoracic surgery; however, we hope that our study could provide a clue for a more refined treatment strategy for early-stage lung cancer. Do Tumor Size and Carcinoembryonic Antigen Level Affect Surgical Management of Partially Solid Early-Stage Lung Cancer?The Annals of Thoracic SurgeryVol. 103Issue 3PreviewWe have read with interest the article by Hattori and colleagues [1]. They found that tumor size affected survival in purely solid cancer, whereas it was not prognostic in purely ground-glass opacity (GGO). These data have already been reported in many articles, but the really surprising finding was that partially solid tumors also were not affected by size or even by the consolidation tumor ratio. To summarize, their results support the fact that the simple presence of a GGO component makes oncologic prognosis favorable. Full-Text PDF