Andrea S Wolf1, Scott J Swanson2, Rowena Yip3, Bian Liu4, Elizabeth S Tarras5, David F Yankelevitz3, Claudia I Henschke3, Emanuela Taioli4, Raja M Flores5. 1. Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: andrea.wolf@mountsinai.org. 2. Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts. 3. Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York. 4. Department of Population Health Science and Policy and Institute of Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York. 5. Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
Abstract
BACKGROUND: The relationship between margin distance and recurrence and survival for stage I non-small cell lung carcinoma (NSCLC) less than or equal to 2 cm is not clear. METHODS: Patient clinicopathologic data were reviewed from a pooled data set of stage I NSCLC lesions less than or equal to 2 cm resected by wedge resection at Brigham and Women's Hospital (BWH) between 2000 and 2005 and the International Early Lung and Cardiac Action Program (I-ELCAP) between 1999 and 2015. Multivariable models were constructed to evaluate the relationship between margin distance and recurrence and survival, adjusting for patient age, sex, tumor size, and histologic type. Optimal margin distance was determined for recurrence-free and overall survival using maximum χ2 values among survival distributions. RESULTS: Of 182 cases, 138 tumors had margin distance reported (113 BWH and 25 I-ELCAP). The average tumor size was 13.3 mm, and margin distance was 8.3 mm. During a mean follow-up of 49.6 months, there were 33 recurrences and 59 deaths. Increased margin distance was independently associated with lower risk of recurrence (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.83-0.98). Margin distance was also independently associated with longer survival (hazard ratio [HR], 0.94; 95% CI, 0.90-0.98). A margin distance greater than 9 mm was associated with longest recurrence-free survival and a margin distance greater than 11 mm was associated with longest overall survival. CONCLUSIONS: Increased margin distance was independently associated with lower risk of recurrence and longer overall survival in patients undergoing wedge resection for NSCLC tumors less than or equal to 2 cm. These findings suggest that with a minimum appropriate margin distance, wedge resection may yield outcomes comparable to those of lobectomy.
BACKGROUND: The relationship between margin distance and recurrence and survival for stage I non-small cell lung carcinoma (NSCLC) less than or equal to 2 cm is not clear. METHODS:Patient clinicopathologic data were reviewed from a pooled data set of stage I NSCLC lesions less than or equal to 2 cm resected by wedge resection at Brigham and Women's Hospital (BWH) between 2000 and 2005 and the International Early Lung and Cardiac Action Program (I-ELCAP) between 1999 and 2015. Multivariable models were constructed to evaluate the relationship between margin distance and recurrence and survival, adjusting for patient age, sex, tumor size, and histologic type. Optimal margin distance was determined for recurrence-free and overall survival using maximum χ2 values among survival distributions. RESULTS: Of 182 cases, 138 tumors had margin distance reported (113 BWH and 25 I-ELCAP). The average tumor size was 13.3 mm, and margin distance was 8.3 mm. During a mean follow-up of 49.6 months, there were 33 recurrences and 59 deaths. Increased margin distance was independently associated with lower risk of recurrence (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.83-0.98). Margin distance was also independently associated with longer survival (hazard ratio [HR], 0.94; 95% CI, 0.90-0.98). A margin distance greater than 9 mm was associated with longest recurrence-free survival and a margin distance greater than 11 mm was associated with longest overall survival. CONCLUSIONS: Increased margin distance was independently associated with lower risk of recurrence and longer overall survival in patients undergoing wedge resection for NSCLC tumors less than or equal to 2 cm. These findings suggest that with a minimum appropriate margin distance, wedge resection may yield outcomes comparable to those of lobectomy.
Authors: David A Mahvi; Rong Liu; Mark W Grinstaff; Yolonda L Colson; Chandrajit P Raut Journal: CA Cancer J Clin Date: 2018-10-17 Impact factor: 508.702
Authors: Mohammadhadi Khorrami; Kaustav Bera; Patrick Leo; Pranjal Vaidya; Pradnya Patil; Rajat Thawani; Priya Velu; Prabhakar Rajiah; Mehdi Alilou; Humberto Choi; Michael D Feldman; Robert C Gilkeson; Philip Linden; Pingfu Fu; Harvey Pass; Vamsidhar Velcheti; Anant Madabhushi Journal: Lung Cancer Date: 2020-02-26 Impact factor: 5.705