Motoki Yano1, Junji Yoshida2, Terumoto Koike3, Kotaro Kameyama4, Akira Shimamoto5, Wataru Nishio6, Kentaro Yoshimoto7, Tomoki Utsumi8, Takayuki Shiina9, Atsushi Watanabe10, Yasushi Yamato11, Takehiro Watanabe12, Yusuke Takahashi13, Makoto Sonobe14, Hiroaki Kuroda15, Makoto Oda16, Masayoshi Inoue17, Masayuki Tanahashi18, Hirofumi Adachi19, Masao Saito20, Masataro Hayashi21, Hajime Otsuka22, Teruaki Mizobuchi23, Yasumitsu Moriya24, Mamoru Takahashi25, Shigeto Nishikawa26, Yuki Matsumura2, Satoru Moriyama27, Takeshi Nishiyama28, Yoshitaka Fujii27. 1. Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Japan motoki@med.nagoya-cu.ac.jp. 2. Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan. 3. Department of Thoracic and Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan. 4. Department of Thoracic Surgery, Kurashiki Central Hospital, Kurashiki, Japan. 5. Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu, Japan. 6. Department of General Thoracic Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan. 7. Department of Thoracic Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan. 8. Department of Surgery, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan. 9. Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan. 10. Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan. 11. Department of Thoracic Surgery, Nagaoka Red Cross Hospital, Nagaoka, Japan. 12. Department of Thoracic Surgery, National Hospital Organization Nishi-Niigata Chuo National Hospital, Niigata, Japan. 13. Department of General Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Tokyo, Japan. 14. Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan. 15. Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan. 16. Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan. 17. Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. 18. Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan. 19. Department of Thoracic Surgery, Hokkaido Cancer Center, Sapporo, Japan. 20. Department of Thoracic Surgery, Tenri Hospital, Nara, Japan. 21. Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan. 22. Department of Chest Surgery, Toho University Omori Medical Center, Tokyo, Japan. 23. Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan. 24. Divison of Thoracic Surgery, Chiba Cancer Center, Chiba, Japan. 25. Department of Chest Surgery, Fukui Red Cross Hospital, Fukui, Japan. 26. Division of Thoracic Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan. 27. Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Japan. 28. Department of Public Health, Aichi Medical University, Nagakute, Japan.
Abstract
OBJECTIVES: A precise preoperative diagnosis of 'very early' lung carcinoma may identify patients who can undergo curative surgery with limited resections. METHODS: Data from a multi-institutional project were collected on 1737 patients who had undergone limited resections (segmentectomy or wedge resection) for T1N0M0 non-small-cell carcinomas. As it was expected, this study was predominantly including ground glass nodules. Computed tomography was used to obtain the ratio of consolidation to the maximal tumour diameter to determine invasive potential of the tumours. Overall and disease-free survivals and recurrence-free proportions were analysed. RESULTS: Median age was 64 years. Mean maximal diameter of the tumours was 1.4±0.5 cm. Overall and recurrence-free survivals after limited lung resection were 94.0 and 91.1% at 5 years, respectively. Recurrence-free proportions were 93.7% at 5 years. Unfavourable prognostic factors in overall survival were lymph node metastasis, interstitial pneumonia, male gender, older age, comorbidities (cardiac disease, diabetes etc.) and consolidation/tumour ratio (C/T)≤0.25. C/T≤0.25 predicted good outcomes especially in cT1aN0M0 disease. In a subclass analysis of cT1N0M0 squamous cell carcinomas, wedge resection was the only unfavourable prognostic factor in both overall and disease-free survivals. CONCLUSIONS: If the patient was 75 years old or younger and was judged fit for lobectomy, limited resection for cStage I non-small-cell lung cancer (NSCLC) showed excellent outcomes and was not inferior to the reported results of lobectomy for small-sized NSCLC. The carcinomas with C/T≤0.25 rarely recur and are especially good candidates for limited resection.
OBJECTIVES: A precise preoperative diagnosis of 'very early' lung carcinoma may identify patients who can undergo curative surgery with limited resections. METHODS: Data from a multi-institutional project were collected on 1737 patients who had undergone limited resections (segmentectomy or wedge resection) for T1N0M0 non-small-cell carcinomas. As it was expected, this study was predominantly including ground glass nodules. Computed tomography was used to obtain the ratio of consolidation to the maximal tumour diameter to determine invasive potential of the tumours. Overall and disease-free survivals and recurrence-free proportions were analysed. RESULTS: Median age was 64 years. Mean maximal diameter of the tumours was 1.4±0.5 cm. Overall and recurrence-free survivals after limited lung resection were 94.0 and 91.1% at 5 years, respectively. Recurrence-free proportions were 93.7% at 5 years. Unfavourable prognostic factors in overall survival were lymph node metastasis, interstitial pneumonia, male gender, older age, comorbidities (cardiac disease, diabetes etc.) and consolidation/tumour ratio (C/T)≤0.25. C/T≤0.25 predicted good outcomes especially in cT1aN0M0 disease. In a subclass analysis of cT1N0M0 squamous cell carcinomas, wedge resection was the only unfavourable prognostic factor in both overall and disease-free survivals. CONCLUSIONS: If the patient was 75 years old or younger and was judged fit for lobectomy, limited resection for cStage I non-small-cell lung cancer (NSCLC) showed excellent outcomes and was not inferior to the reported results of lobectomy for small-sized NSCLC. The carcinomas with C/T≤0.25 rarely recur and are especially good candidates for limited resection.
Authors: Raja M Flores; Daniel Nicastri; Thomas Bauer; Ralph Aye; Shahriyour Andaz; Leslie Kohman; Barry Sheppard; William Mayfield; Richard Thurer; Robert Korst; Michaela Straznicka; Fred Grannis; Harvey Pass; Cliff Connery; Rowena Yip; James P Smith; David F Yankelevitz; Claudia I Henschke; Nasser K Altorki Journal: Ann Surg Date: 2017-05 Impact factor: 12.969