J Thorac Cardiovasc Surg. 2023 Jun 27:S0022-5223(23)00536-6. doi: 10.1016/j.jtcvs.2023.06.010. Online ahead of print.
ABSTRACT
OBJECTIVE: To evaluate whether wedge resection (WR) was appropriate for the patients with peripheral T1N0 solitary subsolid invasive lung adenocarcinoma (LUAD).
METHODS: Patients with peripheral T1N0 solitary subsolid invasive LUAD who received sublobar resection were retrospectively reviewed. Clinicopathologic characteristics, 5-year recurrence-free survival (RFS) and 5-year lung cancer-specific overall survival (LCS-OS) were analyzed. Cox regression model was used to elucidate risk factors for recurrence.
RESULTS: 258 patients receiving WR and 1245 patients receiving segmentectomy (SEG) were included. The mean follow-up time was 36.87±16.21 months. 5-year RFS following WR was 96.89% for patients with ground-glass nodule (GGN) ≤2cm and 0.25< consolidation to tumor ratio (CTR) ≤0.5, not statistically different from 100% for those with GGN≤2cm and CTR≤0.25 (p=0.231). The 5-year RFS was 90.12% for patients with GGN between 2-3cm and CTR≤0.5, significantly lower than that of patients with GGN≤2cm and CTR≤0.25 (p=0.046). For patients with GGN≤2cm and 0.25<CTR≤0.5, 5-year RFS and LCS-OS were 97.87% and 100% following WR versus 97.73% and 92.86% following SEG (RFS: p=0.987; LCS-OS: p=0.199), respectively. For patients with GGN between 2-3cm and CTR≤0.5, 5-year RFS following WR was significantly lower than that following SEG (90.61% vs. 100%, p=0.043). Multi-variable Cox regression analysis showed that STAS, visceral pleural invasion and nerve invasion remained independent risk factors for recurrence of patients with GGN between 2-3cm and CTR≤0.5 following WR.
CONCLUSIONS: WR might be appropriate for patients with invasive LUAD appearing as peripheral GGN≤2cm and CTR≤0.5, but inappropriate for those with invasive LUAD appearing as peripheral GGN between 2-3cm and CTR≤0.5.
PMID:37385528 | DOI:10.1016/j.jtcvs.2023.06.010
