Segmentectomy for clinical stage IA lung adenocarcinoma showing solid dominance on radiology.
OBJECTIVE
This study aimed to compare prognosis after segmentectomy and after lobectomy for radiologically determined solid-dominant clinical stage IA lung adenocarcinoma.


METHODS
From a multicentre database of 610 consecutive patients with clinical stage IA lung adenocarcinoma who underwent complete resection after preoperative high-resolution computed tomography (HRCT) and F-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), 327 patients with a radiologically determined solid-dominant tumour (solid component on HRCT ≥50%) who underwent lobectomy (n = 286) or segmentectomy (n = 41) were included.


RESULTS
No significant difference existed in recurrence-free survival (RFS) between the lobectomy and segmentectomy groups (3-year RFS, 84.4 vs 84.8%, respectively; P = 0.69). There was no significant difference in recurrence pattern between these two groups (local, 5.6 vs 7.3%, P = 0.72; distant, 9.1 vs 4.9%, P = 0.55, respectively). Even in patients with pure solid tumours, no significant difference was observed in RFS between lobectomy and segmentectomy groups (3-year RFS, 76.8 vs 84.7%, respectively; P = 0.48), as well as in those with a mixed ground-glass opacity tumour (3-year RFS, 91.0 vs 85.0%, respectively; P = 0.60). Multivariate Cox analysis demonstrated that solid tumour size on HRCT (P = 0.048) and maximum standardized uptake value (SUVmax) on FDG-PET/CT (P < 0.001), not the surgical procedure (P = 0.40), were independent prognostic factors for RFS.


CONCLUSIONS
RFS depends on solid tumour size on HRCT and SUVmax on FDG-PET/CT, rather than on the surgical procedure, in patients with radiologically detected solid-dominant clinical stage IA lung adenocarcinoma. Patient prognosis is similar after lobectomy and after segmentectomy for solid-dominant tumour.
Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
Yasuhiro
Y
Tsutani
Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
Yoshihiro
Y
Miyata
Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan.
Haruhiko
H
Nakayama
Department of Thoracic Surgery, Cancer Institute Hospital, Tokyo, Japan.
Sakae
S
Okumura
Department of Radiology, Hyogo Cancer Center, Akashi, Japan.
Shuji
S
Adachi
Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan.
Masahiro
M
Yoshimura
Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan morihito@hiroshima-u.ac.jp.
Morihito
M
Okada
D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D000077192:Adenocarcinoma of Lung; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D049268:Positron-Emission Tomography; D011379:Prognosis; D014057:Tomography, X-Ray Computed
Computed tomography; Lung cancer surgery; Positron emission tomography