Consideration of the Optimal Surgical Procedure Based on the Risk of Recurrence in Clinical Stage 0 or IA Lung Adenocarcinoma

Abstract

\n Background\n\n Although sublobar resection is widely performed for early-stage non-small cell lung cancer, what kind of patients should be actively indicated for sublobar resection has not yet been established according to 8th edition of tumor node metastasis classification (TNM). We evaluated the computed tomography (CT) features and optimal surgical procedures of clinical stage 0 or IA adenocarcinoma from the perspective of recurrence.\nMethods\n\nWe retrospectively investigated 508 lung adenocarcinoma diagnosed as c-stage 0 or IA in the 8th edition of TNM classification. A survival analysis was performed according to the clinical T descriptor, CT features and surgical procedures.\nResults\n\nThe tumors were classified as follows: 74 with pure ground glass opacity (GGO), 237 part-solid tumors and 197 solid tumors. The types of surgical procedures were lobectomy (n\u2009=\u2009328), segmentectomy (n\u2009=\u200973) and wedge resection (n\u2009=\u2009107). Clinical T descriptors were cTis in 74 patients, cT1mi in 68 patients, cT1a in 94 patients, cT1b in 181 patients and cT1c in 91 patients. Recurrence was observed 46 cases (9%), including 3 (3.1%) with cT1a, 23 (12.7%) with cT1b and 20 (22.0%) with cT1c. No recurrence was observed in cTis or cT1mi cases. Solid tumors with cT1b recurred more often than part-solid tumors among cT1b cases (6.8% vs. 16.8%) (p\u2009=\u20090.046). There were no marked differences in the recurrence rate between part-solid and solid tumors in the cT1a and cT1c groups. The patients who received sublobar resection developed recurrence more often than the patients who received lobectomy among cT1b cases (10.1% vs. 21.4%) and cT1c cases (18.0% vs. 46.2%) (p\u2009=\u20090.053 and p\u2009=\u20090.023).\nConclusions\n\nPure GGO and cT1mi cases should be actively considered for sublobar resection, while cT1b (especially solid cT1b cases) and cT1c cases should be considered for lobectomy to prevent recurrence.