Abstract
Purpose
This retrospective study was designed to find out the potential indications of completion lobectomy (CL) during wedge resection (WR) operation among patients with lung adenocarcinoma (ADC) ≤3 cm, by the use of Shanghai Chest Hospital Lung Cancer Database.
Patients and methods
There were totally 1938 patients in this study, including 746 WRs and 1192 CLs. The propensity score matching (PSM) was performed to minimize the effect of confounders. Univariable and multivariable cox regressions were analyzed to discover the independent risk factors of recurrence-free survival (RFS) and overall survival (OS). Subgroup analysis and Kaplan–Meier survival curves were performed if necessary.
Results
The 5-year RFS (86.1 vs 91.5%, p = 0.001 for unmatched group; 84 v 92%, p < 0.001 for PSM group) and OS (83.6 vs 91.7%, p < 0.001 for unmatched group; 81.6 vs 88.2%, p < 0.001 for PSM group) all indicated a better prognosis when conducting CL. Subgroup analysis suggested that WR was appropriate for non-invasive ADC. Three prognostic factors (sex, surgical approach and pleural invasion) were correlated with RFS and two (sex and surgical approach) corresponded with OS in invasive ADC through multivariable analysis. Non-lepidic-predominant component showed a better RFS and OS when CL was operated after WR in the subgroup of invasive ADC.
Conclusion
CL was an appropriate remediation to WR when the existence of invasive ADC, especially non-lepidic-predominant one. While WR could be applied if non-invasive ADC was confirmed. Whether lepidic-predominant adenocarcinoma was fit for WR needed further study.
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Abbreviations
- WR:
-
Wedge resection
- CL:
-
Completion lobectomy
- NSCLC:
-
Non-small-cell lung cancer
- ADC:
-
Lung adenocarcinoma
- PSM:
-
Propensity score matching
- RFS:
-
Recurrence-free survival
- OS:
-
Overall survival
- AAH:
-
Atypical adenomatous hyperplasia
- AIS:
-
Adenocarcinoma in situ
- MIA:
-
Minimally invasive adenocarcinoma
- PI:
-
Pleural invasion
- LVI:
-
Lymphovascular invasion
- FS:
-
Frozen section
- FP:
-
Final pathology
- HR:
-
Hazard ratio
- CI:
-
Confidence interval
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Dr. Haiquan Chen is the guarantor of the manuscript. Dr. Yiyang Wang: contributed to conception and study design, acquisition and analysis of data, and writing and revision of the manuscript. Dr. Rui Wang: contributed to conception and study design, acquisition and analysis of data, and writing and revision of the manuscript. Dr. Difan Zheng: contributed to conception and study design, acquisition and analysis of data, and writing and revision of the manuscript. Dr. Baohui Han: contributed to acquisition of data and writing and revision of the manuscript. Dr. Jie Zhang: contributed to acquisition of data and writing and revision of the manuscript. Dr. Heng Zhao: contributed to analysis of data and revision of the manuscript. Dr. Jizhuang Luo: contributed to acquisition of data and revision of the manuscript. Dr. Jiajie Zheng: contributed to acquisition of data and revision of the manuscript. Dr. Tianxiang Chen: contributed to acquisition of data and revision of the manuscript. Dr. Qingyuan Huang: contributed to acquisition of data and revision of the manuscript. Dr. Yihua Sun: contributed to conception and study design, review and revision of the manuscript. Dr. Haiquan Chen: contributed to conception and study design, analysis of data, and review and revision of the manuscript.
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Funding
This work was supported by the National Natural Science Foundation of China (81572253 and 81372525) and Shen-kang Center Project (SKMB1201).
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Written informed consent was obtained from each patient to allow their biological samples to be genetically analyzed.
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Wang, Y., Wang, R., Zheng, D. et al. The indication of completion lobectomy for lung adenocarcinoma ≤3 cm after wedge resection during surgical operation. J Cancer Res Clin Oncol 143, 2095–2104 (2017). https://doi.org/10.1007/s00432-017-2452-0
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DOI: https://doi.org/10.1007/s00432-017-2452-0