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The indication of completion lobectomy for lung adenocarcinoma ≤3 cm after wedge resection during surgical operation

  • Original Article – Clinical Oncology
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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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Authors and Affiliations

Authors

Contributions

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.

Corresponding author

Correspondence to Haiquan Chen.

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Conflict of interest

The authors declare no conflict of interest.

Funding

This work was supported by the National Natural Science Foundation of China (81572253 and 81372525) and Shen-kang Center Project (SKMB1201).

Ethical approval

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.

Informed consent

Written informed consent was obtained from each patient to allow their biological samples to be genetically analyzed.

Appendix 1

Appendix 1

See Tables 5 and 6 and Fig. 3.

Table 5 The Univariable and multivariable cox regression of clinical T1 lung adenocarcinoma underwent wedge resection and completion lobectomy after propensity score matching
Table 6 Subgroup analysis of of clinical T1 lung non-invasive adenocarcinoma underwent wedge resection and completion lobectomy after propensity score matching through univariable and multivariable analysis

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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

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