Outcomes of patients undergoing segmentectomy for occult node-positive clinical stage IA lung cancer Journal Article


Authors: Nobel, T. B.; Tan, K. S.; Adusumilli, P. S.; Bains, M. S.; Downey, R. J.; Gray, K.; Huang, J.; Isbell, J. M.; Molena, D.; Park, B. J.; Rocco, G.; Rusch, V. W.; Sihag, S.; Jones, D. R.; Bott, M. J.
Article Title: Outcomes of patients undergoing segmentectomy for occult node-positive clinical stage IA lung cancer
Abstract: Background: Results of recent clinical trials suggest that segmentectomy may be an acceptable alternative to lobectomy for selected patients with early-stage non-small cell lung cancer (NSCLC). Increased use of segmentectomy may result in a concomitant increase in occult node-positive (N+) disease on surgical pathology examination. The optimal management for such patients remains unknown. Methods: Clinicopathologic data were abstracted from a prospective institutional database to identify patients with pathologic N+ disease after segmentectomy for cT1 N0 M0 NSCLC. Propensity score matching identified a comparable lobectomy cohort for assessment of cumulative incidence of recurrence and overall survival (OS). Results: Of 759 included patients, 27 (4%) had nodal upstaging on the final pathology report. Of these 27 patients, 4 (15%) had skip metastasis to N2 stations, and 20 (74%) received adjuvant therapy; no completion lobectomies were performed. Ten patients (37%) had disease recurrence: 3 isolated locoregional (11%) and 7 distant (26%). The median time to recurrence among patients with recurrence was 1.8 years; OS after recurrence was 3.4 years. After 5:1 matching with 109 patients who underwent lobectomy, all variables were balanced between the groups, except pathologic N2 stage and open surgical approach. The 5-year cumulative incidence of recurrence was not significantly different between segmentectomy and lobectomy (42% vs 52%, respectively; Gray's P = .1). The 5-year OS (63% and 50%) and rate of locoregional recurrence (12% vs 13%) were not statistically different between the groups. Conclusions: Patients with occult N+ disease after segmentectomy for cT1 N0 M0 NSCLC had limited isolated locoregional recurrences and outcomes similar to those in patients who underwent lobectomy. Lobectomy may not provide an advantage in these patients. © 2024 The Society of Thoracic Surgeons
Keywords: adult; cancer survival; controlled study; human tissue; treatment outcome; aged; middle aged; survival rate; retrospective studies; major clinical study; overall survival; histopathology; mortality; cancer recurrence; cancer adjuvant therapy; comparative study; cancer staging; outcome assessment; recurrence risk; lymph node metastasis; lymph nodes; lymphatic metastasis; neoplasm staging; antineoplastic metal complex; neoplasm recurrence, local; lung lobectomy; carcinoma, non-small-cell lung; lung neoplasms; pneumonectomy; cohort analysis; pathology; surgical approach; retrospective study; distant metastasis; protein tyrosine kinase inhibitor; lung tumor; tumor recurrence; lymph node; surgery; epidemiology; pemetrexed; non small cell lung cancer; cumulative incidence; occult cancer; clinical outcome; procedures; propensity score; open surgery; humans; human; male; female; article; segmentectomy
Journal Title: Annals of Thoracic Surgery
Volume: 118
Issue: 3
ISSN: 0003-4975
Publisher: Elsevier Science, Inc.  
Date Published: 2024-09-01
Start Page: 655
End Page: 663
Language: English
DOI: 10.1016/j.athoracsur.2024.05.031
PUBMED: 38866198
PROVIDER: scopus
PMCID: PMC11347119
DOI/URL:
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF. Corresponding MSK author is Matthew J. Bott -- Source: Scopus
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MSK Authors
  1. Valerie W Rusch
    869 Rusch
  2. James Huang
    215 Huang
  3. Bernard J Park
    265 Park
  4. Matthew Bott
    136 Bott
  5. Robert J Downey
    254 Downey
  6. Manjit S Bains
    338 Bains
  7. David Randolph Jones
    418 Jones
  8. Daniela   Molena
    276 Molena
  9. Kay See   Tan
    244 Tan
  10. James Michael Isbell
    128 Isbell
  11. Smita Sihag
    98 Sihag
  12. Tamar B Nobel
    42 Nobel
  13. Gaetano Rocco
    132 Rocco
  14. Katherine D. Gray
    26 Gray