Lung Cancer-specific Overall Survival Research Articles

Sublobectomy for stage IA1-2 invasive lung adenocarcinoma with consolidation tumor ratio ≤ 0.25.

Sublobectomy for early-stage non-small cell lung cancer (NSCLC) remains a matter of debate. This study aimed to discuss the feasibility of sublobectomy in patients with pathological-stage IA1-2 confirmed as pathologically invasive but radiologically noninvasive adenocarcinoma. From 2011 to 2019, we screened clinical stage IA1-IA2 lung cancer patients who underwent surgery at the Guangdong Provincial People's Hospital (GDPH). Inclusion criteria were maximum tumor diameter of 2.0cm or less, consolidation tumor ratio (CTR) ≤ 0.25, and pathologically confirmed invasive adenocarcinoma. Sublobectomy (segmentectomy and wedge resection) and lobectomy groups were created, and propensity scores were computed. The primary endpoints were lung cancer-specific overall survival (LCSS) and LCS- relapse-free survival (LCS-RFS) after adjusting propensity scores. A total of 1731 patients were screened, and 100 patients were enrolled. The lobectomy group had 51 patients and the limited resection group had 49. No cases relapsed, and two patients died from nontumor causes. For the entire cohort, the 5-year LCSS and 5-year LCS-RFS were 100% in the lobectomy and limited resection groups. When propensity scores matched, there were no differences in LCSS and LCS-RFS between the two groups (LCSS:100%, LCS-RFS 100% in lobectomy and limited resection, respectively). Sublobectomy may be curative for pathologically invasive but radiologically noninvasive adenocarcinoma at pathological stage IA1-2.

Predictors of Pathologic Tumor Invasion and Prognosis for Ground Glass Opacity Featured Lung Adenocarcinoma

We make surgical strategies for ground glass opacity (GGO) nodules currently based on thin-section (TS) computed tomography (CT) findings. Whether radiologic measurements could precisely predict tumor invasion and prognosis of GGO-featured lung adenocarcinoma is uncertain. We retrospectively evaluated medical records of patients with radiologic GGO nodules undergoing a surgical procedure at Fudan University Shanghai Cancer Center. The study endpoints were the predictive value and prognostic significance of radiologic measurements (consolidation-to-tumor ratio value, consolidation size, and tumor size) for pathologic lung adenocarcinoma. In this study 736 patients and 841 GGO nodules were included. Five-year lung cancer-specific regression-free survival (LCS-RFS) rate was 95.76% (95% confidence interval [CI], 93.01% to 97.44%). The 5-year LCS overall survival (OS) rate was 98.99% (95% CI, 97.69% to 99.57%). Multivariable analysis showed that tumor invasion (invasive adenocarcinoma [IAD] vs adenocarcinoma in situ [AIS]/minimally invasive adenocarcinoma [MIA], p= 0.020) was the only independent predictor for 5-year LCS-RFS. IAD (hazard ratio, 15.98; 95% CI, 1.55 to 164.35) was correlated with a higher risk ofrecurrence. Kaplan-Meier analysis showed that only tumor invasion status (IAD vs AIS/MIA, p= 0.003) could predict 5-year lung cancer-specific overall survival (LCS-OS), and IAD had a worse LCS-OS than AIS and MIA. A part-solid component (odds ratio [OR], 9.09; 95% CI, 2.71 to 30.47; p= 0.000), large consolidation size (OR, 3.11; 95% CI, 1.03 to 9.40; p= 0.045), and large tumor size (OR, 5.48; 95% CI, 2.68 to 11.19; p= 0.000) were associated with pathologic IAD. For IAD ≤ 20 mm, segmentectomy and lobectomy had better 5-year LCS-RFS than wedge resection, although the difference wasstatistically insignificant (p= 0.367). The three types of surgeries provided the similar 5-year LCS-OS (p= 0.834). Radiologic measurements could not precisely predict tumor invasion and prognosis. Making treatment strategies solely according to TS-CT findings for GGO tumor is inappropriate.

Clinical Significance of Positron Emission Tomography in Subcentimeter Non-Small Cell Lung Cancer

This study evaluated the clinical significance of maximum standardized uptake value (SUVmax) on positron emission tomography (PET) in patients with subcentimeter non-small cell lung cancer (NSCLC). Between 2008 and 2014, 189 patients were investigated preoperatively by PET for c-N0 subcentimeter NSCLC, and SUVmax was reviewed. Pathologic invasiveness (PI) was defined as having at least one of the following factors: lymphatic invasion, vascular invasion, pleural invasion, or nodal metastasis. Survival rates were calculated by Kaplan-Meier estimation methods using the log-rank test. Mean SUVmax was 1.7 ± 1.8 (range, 0.6 to 13.0), and the median was 1.0. PI was found in 28 (15%) patients with subcentimeter NSCLC. Multivariate analysis revealed that SUVmax was an independent significant clinical predictor of PI (p= 0.0251) and a prognostic factor of overall survival (OS) (p= 0.0485). A receiver operating characteristics curve elucidated the predictive cutoff value of PI as SUVmax= 2.0. The high-SUVmax group (SUVmax >2.0; n= 42) had significantly more radiologically pure-solid lesions (91% vs 14%; p < 0.0001) and postoperative nodal involvement (12% vs 0%; p<0.0001) than the low-SUVmax group (SUVmax ≤2.0; n= 147). The 5-year lung cancer-specific OS (LCS-OS) elucidated significant difference between the high-SUVmax and low-SUVmax arms of the study (LCS-OS: 92.3% vs 96.9%, respectively; p= 0.0054), and cancer recurrence was found exclusively in pure-solid subcentimeter NSCLC on thin-section computed tomography. In the high-SUVmax arm of the study, lobectomy was associated with better 3-year recurrence-free survival compared with sublobar resection despite the subcentimeter disease (88.3% vs 50.0%; p= 0.0453). SUVmax on PET reflected tumor invasiveness and had a great impact on the prognosis of subcentimeter NSCLC, especially when a tumor showed a pure-solid appearance on a thin-section computed tomography scan.