title: Risk factor analysis of locoregional recurrence after sublobar resection in patients with clinical stage IA non-small cell lung cancer.
abstract: OBJECTIVE
  Although lobectomy is the standard surgical procedure for operable non-small cell lung cancer (NSCLC), sublobar resection also has been undertaken for various reasons. The aim of this study was to identify risk factors of locoregional recurrence and poor disease-specific survival in patients with clinical stage IA NSCLC undergoing sublobar resection.
  
  
  METHODS
  We retrospectively reviewed 328 patients with clinical stage IA NSCLC who underwent segmentectomy or wedge resection. Demographic, clinical, and pathologic factors were analyzed using the log-rank test as univariate analyses, and all factors were entered into a Cox proportional hazards regression model for multivariate analyses to identify independent predictors of locoregional recurrence and poor disease-specific survival.
  
  
  RESULTS
  The 5- and 10-year locoregional recurrence-free probabilities were 84.8% and 83.6%, respectively, and the 5- and 10-year disease-specific survivals were 83.6% and 73.6%, respectively. Four independent predictors of locoregional recurrence were identified: wedge resection (hazard ratio [HR], 5.787), microscopic positive surgical margin (HR, 3.888), visceral pleural invasion (HR, 2.272), and lymphatic permeation (HR, 3.824). Independent predictors of poor disease-specific survival were identified as follows: smoking status (Brinkman Index; HR, 1.001), wedge resection (HR, 3.183), microscopic positive surgical margin (HR, 3.211), visceral pleural invasion (HR, 2.553), and lymphatic permeation (HR, 3.223). All 4 predictors of locoregional recurrence also were identified as independent predictors of poor disease-specific survival.
  
  
  CONCLUSIONS
  Segmentectomy should be the surgical procedure of first choice in patients with clinical stage IA NSCLC who are being considered for sublobar resection. Patients having tumors presenting with no suspicious of pleural involvement would be suitable candidates for sublobar resection.
authors.affiliation: Division of Chest Surgery, Niigata Cancer Center Hospital, Niigata, Japan. koike@niigata-cc.jp
authors.forename: Terumoto
authors.initials: T
authors.lastname: Koike
authors.forename: Teruaki
authors.initials: T
authors.lastname: Koike
authors.forename: Katsuo
authors.initials: K
authors.lastname: Yoshiya
authors.forename: Masanori
authors.initials: M
authors.lastname: Tsuchida
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Toyabe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D010994:Pleura / Q000473:pathology; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: 10; 10.4; BI; Brinkman Index; CEA; CI; CT; Cons/Tumor ratio; HR; LCSG; Lung Cancer Study Group; NSCLC; PET; carcinoembryonic antigen; computed tomography; confidence interval; consolidation/tumor ratio; hazard ratio; non–small cell lung cancer; positron emission tomography