Predictive factors of recurrence after resection of subsolid clinical stage IA lung adenocarcinoma

• Published in: Thoracic cancer Vol. 12; no. 6; pp. 941 - 948
• Main Authors: Im, Dong Jin, Lee, Sang Min, Han, Kyunghwa, Park, Chul Hwan, Lee, Ji Won, Hwang, Sung Ho, Seo, Jae Seung, Kwon, Woocheol, Lee, Kye Ho, Hur, Jin
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01-03-2021; John Wiley & Sons, Inc; Wiley
• Subjects: Cardiovascular disease; Classification; Classification schemes; Diabetes; Hepatitis; Hypertension; lobectomy; lung adenocarcinoma; Lung cancer; Medical prognosis; Medical screening; Original; Patients; segmentectomy; Software; subsolid nodule; Surgery; Surgical outcomes; wedge resection; wedge resection; lobectomy; segmentectomy; lung adenocarcinoma; subsolid nodule
• ISSN: 1759-7706; 1759-7714
• DOI: 10.1111/1759-7714.13876

Background
Ongoing studies are currently investigating the extent of surgical resection required for subsolid cancers. This study aimed to investigate the predictive factors related to recurrence in patients with clinical stage IA subsolid cancer who underwent either lobectomy or sublobar resection.
Methods
This was a prospective multicenter observational study conducted in eight qualifying university teaching hospitals between April 2014 and December 2016. A total of 173 patients with subsolid nodules pathologically confirmed to have primary lung adenocarcinoma and stage IA disease were included in the final analysis. All patients underwent lobectomy, segmentectomy, or wedge resection performed by experienced thoracoscopic surgeons at each site. The surgical procedure was chosen based on the decision of the surgeons involved. The primary endpoint was time to recurrence (TTR).
Results
The study population was 43.9% (76 of 173) male with a mean age of 60.7 years. During the median follow‐up period of 5.01 years, nine patients (5%) experienced disease recurrence. In the multivariable analysis, tumor size (size ≥2 cm) (hazard ratio: 73.717, 95% confidence interval [CI]: 3.635–895.036; p < 0.001) and stage IA3 (hazard ratio: 62.010, 95% CI: 2.837–855.185; p < 0.001) were independent predictors of tumor recurrence. When analyzing the recurrence outcome in patients according to surgical procedure, no significant difference was found in TTR among the three groups (i.e., lobectomy, segmentectomy, and wedge resection; p = 0.99).
Conclusions
Patients with radiologically subsolid lung adenocarcinoma measuring <3 cm could be candidates for sublobar resection instead of lobectomy.
Highlights
This study aimed to investigate risk factors related to recurrence in patients with clinical stage IA subsolid cancer who underwent either lobectomy or sublobar resection.
The main results showed excellent surgical outcomes regardless of surgical procedure, subsolid nodule subtype and solid component size.
Our results validate subjects eligible for sublobar resection recommended by the NCCN 2020 guideline and provide surgeons with a rationale for choosing a less extensive surgical alternative for clinical stage IA adenocarcinomas observed as subsolid nodules without compromising patient outcomes.