Geun Dong Lee1, Dong Kwan Kim2, Se Jin Jang3, Se Hoon Choi4, Hyeong Ryul Kim4, Yong-Hee Kim4, Seung-Il Park4. 1. Department of Thoracic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. 2. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea dkkim@amc.seoul.kr. 3. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. 4. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Abstract
OBJECTIVES: We aimed to evaluate the significance of microscopic residual disease at the bronchial resection margin (R1-BRM) after curative surgery for non-small cell lung cancer (NSCLC). METHODS: Retrospective review was performed on 1800 patients from 1994 to 2012. We compared recurrence and survival between 1740 patients with R0-resection at the BRM (R0-BRM) and 60 patients with R1-resection at the BRM (R1-BRM), comprising 18 cases of mucosal carcinoma in situ (R1-CIS) and 42 cases of extramucosal residual disease (R1-EMD). RESULTS: Stump recurrence occurred in 43 patients. The 5-year cumulative incidence of stump recurrence in group R0, R1-CIS and R1-EMD was 3.1, 5.6 and 12.2%, respectively. Significant differences of stump recurrence were observed between the groups (R0 versus R1-CIS, P = 0.008; R0 versus R1-EMD, P = 0.007). In Stage IB or II disease, the overall survival rate for R1-EMD was significantly lower than that for R0-BRM (P = 0.014), whereas the difference in overall survival rate between the R1-CIS group and the R0-BRM was not significant (P = 0.37). In Stage IIIA disease, the overall survival rates for R1-CIS (P = 0.87) and R1-EMD (P = 0.45) were not significantly different from that for R0-BRM. CONCLUSIONS: R1-BRM comprises a higher rate of stump recurrence, compared with that of R0-BRM. Herein, R1-EMD was associated with poor overall survival in Stage IB/II disease. In Stage IIIA disease, R1-BRM showed similar overall survival rate to that for R0-BRM, although the number of patients was too small to draw definitive conclusions thereon.
OBJECTIVES: We aimed to evaluate the significance of microscopic residual disease at the bronchial resection margin (R1-BRM) after curative surgery for non-small cell lung cancer (NSCLC). METHODS: Retrospective review was performed on 1800 patients from 1994 to 2012. We compared recurrence and survival between 1740 patients with R0-resection at the BRM (R0-BRM) and 60 patients with R1-resection at the BRM (R1-BRM), comprising 18 cases of mucosal carcinoma in situ (R1-CIS) and 42 cases of extramucosal residual disease (R1-EMD). RESULTS: Stump recurrence occurred in 43 patients. The 5-year cumulative incidence of stump recurrence in group R0, R1-CIS and R1-EMD was 3.1, 5.6 and 12.2%, respectively. Significant differences of stump recurrence were observed between the groups (R0 versus R1-CIS, P = 0.008; R0 versus R1-EMD, P = 0.007). In Stage IB or II disease, the overall survival rate for R1-EMD was significantly lower than that for R0-BRM (P = 0.014), whereas the difference in overall survival rate between the R1-CIS group and the R0-BRM was not significant (P = 0.37). In Stage IIIA disease, the overall survival rates for R1-CIS (P = 0.87) and R1-EMD (P = 0.45) were not significantly different from that for R0-BRM. CONCLUSIONS: R1-BRM comprises a higher rate of stump recurrence, compared with that of R0-BRM. Herein, R1-EMD was associated with poor overall survival in Stage IB/II disease. In Stage IIIA disease, R1-BRM showed similar overall survival rate to that for R0-BRM, although the number of patients was too small to draw definitive conclusions thereon.
Authors: Ziqing Zeng; Bo Yan; Yulong Chen; Lianmin Zhang; Jianquan Zhu; Fan Yang; Feng Wei; Terence Chi Chun Tam; Diego Kauffmann-Guerrero; Ross Andrew Soo; Xiubao Ren; Jian You Journal: Transl Lung Cancer Res Date: 2020-12