Skip to main content

Advertisement

SpringerLink
Log in

Characteristics and risk factors of recurrence in clinical stage I non-small cell lung cancer patients undergoing anatomic segmentectomy

  • Original Article
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Objective

Although lobectomy is the standard surgical procedure for small-sized non-small cell lung cancer (NSCLC), segmentectomy has been performed for various reasons. The aim of this study was to investigate the characteristics of and risk factors for recurrence in early-stage NSCLC patients undergoing segmentectomy.

Methods

We retrospectively reviewed 179 patients with clinical stage I NSCLC who underwent segmentectomy. Preoperative factors were analyzed using the log-rank test for univariate analyses. Multivariate analyses were performed using a Cox proportional hazards regression model to identify independent risk factors for recurrence. For the significant factors, optimal cutoff points were determined by receiver operating characteristic (ROC) analysis.

Results

During the follow-up period of 51 months, 18 patients developed recurrence; 5 had locoregional (including 2 with margin recurrences only), 9 had distant, and 4 had both locoregional and distant recurrence. Multivariate and ROC analysis identified radiologic solid tumor size with a cutoff point of 1.5 cm as an independent risk factor for recurrence. Three patients in the solid size < 1.5 cm group (n = 119) developed recurrence, 2 of whom had surgical margin recurrence, compared to 15 patients in the solid size ≥ 1.5 cm group (n = 60).

Conclusions

The indication for segmentectomy should be decided upon with caution, and the segments to be resected should be carefully considered to secure an appropriate surgical margin in this low-risk subgroup of patients because they may have a relatively higher risk of surgical margin recurrence, despite being at decreased risk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. 1995;60:615–22.

    Article  CAS  Google Scholar 

  2. Keenan RJ, Landreneau RJ, Maley RH Jr, Singh D, Macherey R, Bartley S, et al. Segmental resection spares pulmonary function in patients with stage I lung cancer. Ann Thorac Surg. 2004;78:228–33.

    Article  Google Scholar 

  3. Koike T, Koike T, Sato S, Hashimoto T, Aoki T, Yoshiya K, et al. Lobectomy and limited resection in small-sized peripheral non-small cell lung cancer. J Thorac Dis. 2016;8:3265–74.

    Article  Google Scholar 

  4. Schuchert MJ, Kilic A, Pennathur A, Nason KS, Wilson DO, Luketich JD, et al. Oncologic outcomes after surgical resection of subcentimeter non-small cell lung cancer. Ann Thorac Surg. 2011;91:1681–7.

    Article  Google Scholar 

  5. Koike T, Yamato Y, Yoshiya K, Shimoyama T, Suzuki R. Intentional limited pulmonary resection for peripheral T1 N0 M0 small-sized lung cancer. J Thorac Cardiovasc Surg. 2003;125:924–8.

    Article  Google Scholar 

  6. Okada M, Koike T, Higashiyama M, Yamato Y, Kodama K, Tsubota N. Radical sublobar resection for small-sized non-small cell lung cancer: a multicenter study. J Thorac Cardiovasc Surg. 2006;132:769–75.

    Article  Google Scholar 

  7. Koike T, Koike T, Yoshiya K, Tsuchida M, Toyabe S. Risk factor analysis of locoregional recurrence after sublobar resection in patients with clinical stage IA non-small cell lung cancer. J Thorac Cardiovasc Surg. 2013;146:372–8.

    Article  Google Scholar 

  8. Brown LM, Louie BE, Jackson N, Farivar AS, Aye RW, Vallieres E. Recurrence and survival after segmentectomy in patients with prior lung resection for early-stage non-small cell lung cancer. Ann Thorac Surg. 2016;102:1110–8.

    Article  Google Scholar 

  9. Kamigaichi A, Tsutani Y, Fujiwara M, Mimae T, Miyata Y, Okada M. Postoperative recurrence and survival after segmentectomy for clinical stage 0 or IA lung cancer. Clin Lung Cancer. 2019;20(5):397–403.e1.

    Article  Google Scholar 

  10. Nomori H, Mori T, Shiraishi A, Fujino K, Sato Y, Ito T, et al. Long-term prognosis after segmentectomy for cT1 N0 M0 non-small cell lung cancer. Ann Thorac Surg. 2019;107:1500–6.

    Article  Google Scholar 

  11. Blasberg JD, Pass HI, Donington JS. Sublobar resection: a movement from the Lung Cancer Study Group. J Thorac Oncol. 2010;5:1583–93.

    Article  Google Scholar 

  12. Sobin LH, Gospodarowicz MK, Wittekind C, International Union against Cancer. TNM classification of malignant tumours. 7th ed. Chichester: Wiley-Blackwell;2010.

    Google Scholar 

  13. Koike T, Goto T, Kitahara A, Sato S, Saitoh M, Hashimoto T, et al. Characteristics and timing of recurrence during postoperative surveillance after curative resection for lung adenocarcinoma. Surg Today. 2017;47:1469–75.

    Article  Google Scholar 

  14. Brinkman GL, Coates EO Jr. The effect of bronchitis, smoking, and occupation on ventilation. Am Rev Respir Dis. 1963;87:684–93.

    CAS  PubMed  Google Scholar 

  15. Suzuki K, Koike T, Asakawa T, Kusumoto M, Asamura H, Nagai K, et al. A prospective radiological study of thin-section computed tomography to predict pathological noninvasiveness in peripheral clinical IA lung cancer (Japan Clinical Oncology Group 0201). J Thorac Oncol. 2011;6:751–6.

    Article  Google Scholar 

  16. Handa Y, Tsutani Y, Mimae T, Tasaki T, Miyata Y, Okada M. Surgical outcomes of complex versus simple segmentectomy for stage I non-small cell lung cancer. Ann Thorac Surg. 2019;107:1032–9.

    Article  Google Scholar 

  17. Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Shimizu H, Endo S, Natsugoe S, Doki Y, Hirata Y, et al. Thoracic and cardiovascular surgery in Japan in 2016: annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2019;67:377–411.

    Article  Google Scholar 

  18. Schuchert MJ, Pettiford BL, Pennathur A, Abbas G, Awais O, Close J, et al. Anatomic segmentectomy for stage I non-small-cell lung cancer: comparison of video-assisted thoracic surgery versus open approach. J Thorac Cardiovasc Surg. 2009;138(1318–25):e1.

    Google Scholar 

  19. Koike T, Koike T, Yamato Y, Yoshiya K, Toyabe S. Prognostic predictors in non-small cell lung cancer patients undergoing intentional segmentectomy. Ann Thorac Surg. 2012;93:1788–94.

    Article  Google Scholar 

  20. Lee KH, Goo JM, Park SJ, Wi JY, Chung DH, Go H, et al. Correlation between the size of the solid component on thin-section CT and the invasive component on pathology in small lung adenocarcinomas manifesting as ground-glass nodules. J Thorac Oncol. 2014;9:74–82.

    Article  Google Scholar 

  21. Aokage K, Miyoshi T, Ishii G, Kusumoto M, Nomura S, Katsumata S, et al. Clinical and pathological staging validation in the eighth edition of the TNM classification for lung cancer: correlation between solid size on thin-section computed tomography and invasive size in pathological findings in the new T classification. J Thorac Oncol. 2017;12:1403–12.

    Article  Google Scholar 

  22. Brierley J, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. 8th ed. Chichester: Wiley; 2017.

    Google Scholar 

  23. Koike T, Kitahara A, Sato S, Hashimoto T, Aoki T, Koike T, et al. Lobectomy versus segmentectomy in radiologically pure solid small-sized non-small cell lung cancer. Ann Thorac Surg. 2016;101:1354–60.

    Article  Google Scholar 

  24. Nakao M, Yoshida J, Goto K, Ishii G, Kawase A, Aokage K, et al. Long-term outcomes of 50 cases of limited-resection trial for pulmonary ground-glass opacity nodules. J Thorac Oncol. 2012;7:1563–6.

    Article  Google Scholar 

  25. Schuchert MJ, Pettiford BL, Keeley S, D’Amato TA, Kilic A, Close J, et al. Anatomic segmentectomy in the treatment of stage I non-small cell lung cancer. Ann Thorac Surg. 2007;84:926–32.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan

    Terumoto Koike, Akihiro Nakamura, Yuki Shimizu, Tatsuya Goto, Seijiro Sato & Masanori Tsuchida

  2. Niigata University Crisis Management Office, Niigata University, Niigata, Japan

    Shin-ichi Toyabe

Authors
  1. Terumoto Koike
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akihiro Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuki Shimizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tatsuya Goto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Seijiro Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shin-ichi Toyabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masanori Tsuchida
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Terumoto Koike.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Koike, T., Nakamura, A., Shimizu, Y. et al. Characteristics and risk factors of recurrence in clinical stage I non-small cell lung cancer patients undergoing anatomic segmentectomy. Gen Thorac Cardiovasc Surg 68, 1011–1017 (2020). https://doi.org/10.1007/s11748-020-01338-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-020-01338-x

Keywords

Search

Navigation