European multicentre study evaluating the prognosis of peripheral early-stage lung adenocarcinoma patients operated on by segmentectomy or lobectomy

• Published in: European journal of cardio-thoracic surgery Vol. 66; no. 5
• Main Authors: Lula, Lukadi Joseph, Costa, Rita, Rushwan, Amr, Barreda, Clara Forcada, Domjan, Matic, Marinucci, Beatrice Trabalza, Jasovic, Crt, Özgür, Emrah Gökay, Savu, Cornel, Rendina, Erino Angelo, Bekiroglu, Nural, Fernandes, Pedro, Jimenez, Marcelo, Stupnik, Tomaz, D’Andrilli, Antonio, Martinod, Emmanuel, Brunelli, Alessandro
• Format: Journal Article
• Language: English
• Published: Germany Oxford University Press 04-11-2024
• Subjects: Segmentectomy; Prognosis; Lung cancer; Adenocarcinoma patterns
• ISSN: 1873-734X; 1873-734X
• DOI: 10.1093/ejcts/ezae388

Abstract
OBJECTIVES
To analyse impact of segmentectomy on oncological outcomes of different peripheral early-stage lung adenocarcinoma patterns.
METHODS
Retrospective multicentre study including patients who underwent either lobectomy or segmentectomy in 6 European centres from 2015 to 2021, for ≤2 cm pathological peripheral lung adenocarcinoma. Overall and disease-free survivals were assessed by cox-regression and lung cancer-specific survival by competing regression analyses to adjust for patient- and tumour-related factors both in the entire dataset and the in aggressive adenocarcinoma patterns dataset.
RESULTS
Lobectomy and segmentectomy were performed in 481 (71%) and 193 (29%) patients, respectively. Propensity score matching was performed (n = 191). One hundred and 8 patients had a least an aggressive pattern. Five-year disease-free, overall and lung cancer-specific survivals were similar between patients who underwent lobectomy or segmentectomy in both entire and aggressive pattern datasets. In patients with aggressive pattern, 5-year disease-free (lobectomy 87.3%; segmentectomy 86.6%, P = 0.62), overall (lobectomy 86.4%; segmentectomy 95.6%, P = 0.61) and lung cancer-specific (lobectomy 100%; segmentectomy 95.6%, P = 0.13) survivals did not differ. Segmentectomy was not an independent risk factor for disease-free survival, neither for overall survival nor for lung cancer-specific survival in any of the 2 datasets. In patients with aggressive pattern, loco-regional recurrence (linearized risks: lobectomy 8.21; segmentectomy 11.3) was higher in patients who underwent segmentectomy.
CONCLUSIONS
Resection should not be extended (to lobectomy) on patients who underwent segmentectomy for pathologically proven early-stage adenocarcinoma with aggressive patterns.
Adenocarcinoma is the largest subset of lung cancer worldwide [1].
Graphical abstract