Sublobar resection as effective as lobectomy for selected early lung cancer patients
medwireNews: Patients with clinical stage IA lung adenocarcinoma who meet specific criteria for node-negative disease achieve similar rates of 5-year recurrence-free survival (RFS) and overall survival (OS) after undergoing sublobar resection as they do after a lobectomy, indicate Japanese research results.
The findings are in contrast to previous studies that showed survival outcomes after limited resections are inferior to those after standard lobectomies.
Of the 618 patients enrolled in the study, 325 met the researchers' criteria for node-negative disease, defined as a solid tumour size of less than 0.8 cm on high-resolution computed tomography, or a maximum standard uptake value (SUVmax) of less than 1.5 on [18F]-fluoro-2-deoxy-ᴅ-glucose positron emission tomography or computed tomography.
These node-negative patients had significantly longer RFS and OS, at 96.6% and 95.9%, respectively, than their counterparts who did not meet the criteria, at a respective 75.5% and 83.1%, report Morihito Okada (Hiroshima University) and colleagues in The Annals of Thoracic Surgery.
Furthermore, RFS and OS rates at 5 years after surgery were not significantly different among the node-negative patients who had undergone sublobar resection, at 97.2% and 95.9%, respectively, compared with their peers who had undergone standard lobectomy, at 96.0% and 95.9%.
“A benefit of sublobar resection is preservation of lung function”, writes the team.
Interestingly, 40% of the 164 patients in the cohort who had stage T1b tumours met the criteria for node-negative disease, remark Okada et al. Furthermore, none of these patients developed recurrences during the median 43-month study follow-up.
This suggests that even stage T1b patients could be candidates for sublobar resection if they fit the criteria and have adequate surgical margins, remarks the team.
In multivariate analysis of all patients adjusted for preoperative variables as well as type of surgery, solid tumour size and SUVmax – as specified by the node-negative disease criteria – significantly independently predicted RFS with hazard ratios of 2.04 and 1.15. Among stage T1b patients, only SUVmax significantly predicted RFS.
“A prospective study to assess the prognostic significance of sublobar resection for patients who meet our proposed [node-negative] criteria is warranted”, suggest Okada and co-authors.
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By Sarah Pritchard, medwireNews Reporter