Survival of 1737 lobectomy-tolerable patients who underwent limited resection for cStage IA non-small-cell lung cancer.
OBJECTIVE
A precise preoperative diagnosis of 'very early' lung carcinoma may identify patients who can undergo curative surgery with limited resections.


METHODS
Data from a multi-institutional project were collected on 1737 patients who had undergone limited resections (segmentectomy or wedge resection) for T1N0M0 non-small-cell carcinomas. As it was expected, this study was predominantly including ground glass nodules. Computed tomography was used to obtain the ratio of consolidation to the maximal tumour diameter to determine invasive potential of the tumours. Overall and disease-free survivals and recurrence-free proportions were analysed.


RESULTS
Median age was 64 years. Mean maximal diameter of the tumours was 1.4±0.5 cm. Overall and recurrence-free survivals after limited lung resection were 94.0 and 91.1% at 5 years, respectively. Recurrence-free proportions were 93.7% at 5 years. Unfavourable prognostic factors in overall survival were lymph node metastasis, interstitial pneumonia, male gender, older age, comorbidities (cardiac disease, diabetes etc.) and consolidation/tumour ratio (C/T)≤0.25. C/T≤0.25 predicted good outcomes especially in cT1aN0M0 disease. In a subclass analysis of cT1N0M0 squamous cell carcinomas, wedge resection was the only unfavourable prognostic factor in both overall and disease-free survivals.


CONCLUSIONS
If the patient was 75 years old or younger and was judged fit for lobectomy, limited resection for cStage I non-small-cell lung cancer (NSCLC) showed excellent outcomes and was not inferior to the reported results of lobectomy for small-sized NSCLC. The carcinomas with C/T≤0.25 rarely recur and are especially good candidates for limited resection.
Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Japan motoki@med.nagoya-cu.ac.jp.
Motoki
M
Yano
Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan.
Junji
J
Yoshida
Department of Thoracic and Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
Terumoto
T
Koike
Department of Thoracic Surgery, Kurashiki Central Hospital, Kurashiki, Japan.
Kotaro
K
Kameyama
Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
Akira
A
Shimamoto
Department of General Thoracic Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan.
Wataru
W
Nishio
Department of Thoracic Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan.
Kentaro
K
Yoshimoto
Department of Surgery, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan.
Tomoki
T
Utsumi
Department of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Takayuki
T
Shiina
Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
Atsushi
A
Watanabe
Department of Thoracic Surgery, Nagaoka Red Cross Hospital, Nagaoka, Japan.
Yasushi
Y
Yamato
Department of Thoracic Surgery, National Hospital Organization Nishi-Niigata Chuo National Hospital, Niigata, Japan.
Takehiro
T
Watanabe
Department of General Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Tokyo, Japan.
Yusuke
Y
Takahashi
Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan.
Makoto
M
Sonobe
Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
Hiroaki
H
Kuroda
Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan.
Makoto
M
Oda
Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Masayoshi
M
Inoue
Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
Masayuki
M
Tanahashi
Department of Thoracic Surgery, Hokkaido Cancer Center, Sapporo, Japan.
Hirofumi
H
Adachi
Department of Thoracic Surgery, Tenri Hospital, Nara, Japan.
Masao
M
Saito
Department of Surgery and Clinical Science, Division of Chest Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
Masataro
M
Hayashi
Department of Chest Surgery, Toho University Omori Medical Center, Tokyo, Japan.
Hajime
H
Otsuka
Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
Teruaki
T
Mizobuchi
Divison of Thoracic Surgery, Chiba Cancer Center, Chiba, Japan.
Yasumitsu
Y
Moriya
Department of Chest Surgery, Fukui Red Cross Hospital, Fukui, Japan.
Mamoru
M
Takahashi
Division of Thoracic Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan.
Shigeto
S
Nishikawa
Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan.
Yuki
Y
Matsumura
Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Japan.
Satoru
S
Moriyama
Department of Public Health, Aichi Medical University, Nagakute, Japan.
Takeshi
T
Nishiyama
Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Japan.
Yoshitaka
Y
Fujii
D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods* / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult
Limited resection; Lung cancer; Segmentectomy; Wedge resection