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 Matsumura2,27, Satoru Moriyama28, Yoshitaka Fujii28. 1. Department of Oncology, Immunology and Surgery, Nagoya City, University Graduate School of Medical Sciences, 1 Kawasumi, 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 Surgery, Teikyo University School of Medicine, 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. Division of Thoracic Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, 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, 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. Division 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. Division of Chest Surgery, Fukushima Medical University, Fukushima, Japan. 28. Department of Oncology, Immunology and Surgery, Nagoya City, University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan.
Abstract
OBJECTIVE: A precise preoperative diagnosis of in situ or minimally invasive carcinoma may identify patients who can be treated by limited resection. Although some clinical trials of limited resection for lung cancer have started, it will take a long time before the results will be published. We have already reported a large-scale study of limited resection. We herein report the data for a subclass analysis according to differences in pathology. METHODS: Data from multiple institutions were collected on 1710 patients who had undergone limited resection (segmentectomy or wedge resection) for cT1N0M0 non-small cell carcinoma. The disease-free survival (DFS) and recurrence-free proportion (RFP) were analyzed. Small cell carcinomas and carcinoid tumors were excluded from this analysis. Adenocarcinomas were sub-classified into four groups using two factors, the ratio of consolidation to the tumor diameter (C/T) and the tumor diameter alone. RESULTS: The median patient age was 64 (20-75) years old. The mean maximal diameter of the tumors was 1.5 ± 0.5 cm. The DFS and RFP at 5 years based on the pathology were 92.2 and 94.7 % in adenocarcinoma (n = 1575), 76.3 and 82.4 % in squamous cell carcinoma (SqCC) (n = 100), and 73.6 and 75.9 % in patients with other tumors (n = 35). The prognosis of adenocarcinoma in both groups A (C/T ≤0.25 and tumor diameter ≤2.0 cm) and B (C/T ≤0.25 and tumor diameter >2.0 cm) was good. In SqCC, only segmentectomy was a favorable prognostic factor. In the groups with other pathologies, large cell carcinomas were worse in prognosis (the both DFS and RFP: 46.3 %). CONCLUSION: Knowing the pathological diagnosis is important to determine the indications for limited resection. Measurement of the tumor diameter and C/T was useful to determine the indications for limited resection for adenocarcinoma. Limited resection for adenocarcinomas is similar with a larger resection, while the technique should be performed with caution in squamous cell carcinoma and other pathologies.
OBJECTIVE: A precise preoperative diagnosis of in situ or minimally invasive carcinoma may identify patients who can be treated by limited resection. Although some clinical trials of limited resection for lung cancer have started, it will take a long time before the results will be published. We have already reported a large-scale study of limited resection. We herein report the data for a subclass analysis according to differences in pathology. METHODS: Data from multiple institutions were collected on 1710 patients who had undergone limited resection (segmentectomy or wedge resection) for cT1N0M0 non-small cell carcinoma. The disease-free survival (DFS) and recurrence-free proportion (RFP) were analyzed. Small cell carcinomas and carcinoid tumors were excluded from this analysis. Adenocarcinomas were sub-classified into four groups using two factors, the ratio of consolidation to the tumor diameter (C/T) and the tumor diameter alone. RESULTS: The median patient age was 64 (20-75) years old. The mean maximal diameter of the tumors was 1.5 ± 0.5 cm. The DFS and RFP at 5 years based on the pathology were 92.2 and 94.7 % in adenocarcinoma (n = 1575), 76.3 and 82.4 % in squamous cell carcinoma (SqCC) (n = 100), and 73.6 and 75.9 % in patients with other tumors (n = 35). The prognosis of adenocarcinoma in both groups A (C/T ≤0.25 and tumor diameter ≤2.0 cm) and B (C/T ≤0.25 and tumor diameter >2.0 cm) was good. In SqCC, only segmentectomy was a favorable prognostic factor. In the groups with other pathologies, large cell carcinomas were worse in prognosis (the both DFS and RFP: 46.3 %). CONCLUSION: Knowing the pathological diagnosis is important to determine the indications for limited resection. Measurement of the tumor diameter and C/T was useful to determine the indications for limited resection for adenocarcinoma. Limited resection for adenocarcinomas is similar with a larger resection, while the technique should be performed with caution in squamous cell carcinoma and other pathologies.
Authors: Ramón Rami-Porta; Vanessa Bolejack; John Crowley; David Ball; Jhingook Kim; Gustavo Lyons; Thomas Rice; Kenji Suzuki; Charles F Thomas; William D Travis; Yi-Long Wu Journal: J Thorac Oncol Date: 2015-07 Impact factor: 15.609