Oncological outcomes of sublobar resection for clinical-stage IA high-risk non-small cell lung cancer patients with a radiologically solid appearance on computed tomography.

OBJECTIVES: Our study aim was to evaluate oncological outcomes after compromised sublobar resection for high-risk clinical-stage IA radiologically solid non-small cell lung cancer (NSCLC), and to investigate potential clinical predictors of improved survival.
METHODS: Among 1109 resected clinical-stage IA NSCLC from 2008 to 2013, 115 (10 %) patients who presented radiologically solid, i.e., invasive appearances on thin-section computed tomography (CT) and were poor candidates for lobectomy underwent compromised sublobar resection. Radiologically solid lung cancer was defined as 0.5 ≤ consolidation/tumor ratio based on thin-section CT scan.
RESULTS: The high-risk cohorts consisted of 65 men and 50 women, with an average age of 71.2 years. The 3-year overall survival (OS) and relapse-free survival were 82.2 and 72.2 % with 34 months of mean follow-up period. A multivariate analysis identified tumor size and carcinoembryonic antigen as significant, consolidation status as marginally significant clinical predictors of survival (p = 0.0141, 0.0426, 0.0623). When the patients were divided based on the number of negative predictors, the 3-year OS of the patients who met neither or one of these negative predictors (n = 64) was 98.4 % despite their anticipated risks, while that of the patients with 2 negative predictors was 71.5 % (n = 38), and the patients who met all of the poor conditions (n = 13) was 37.1 % even in clinical-stage IA disease (p < 0.0001).
CONCLUSIONS: Among clinical-stage IA radiologically solid NSCLC patients who are not lobectomy candidates due to the anticipated risk, sublobar resection could provide acceptable oncological outcomes if patients show positive clinical predictors to improve their survival.