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Outcomes and predictive factors for pathological node-positive in radiographically pure-solid, small-sized lung adenocarcinoma

  • Hiroyuki Kayata
  • Mitsuhiro Isaka
  • Yukihiro Terada
  • Kiyomichi Mizuno
  • Yoshiyuki Yasuura
  • Hideaki Kojima
  • Yasuhisa Ohde
Original Article
  • 20 Downloads

Abstract

Objectives

The indication of limited resection for radiographically pure-solid, small-sized lung adenocarcinoma is controversial. This study aimed to reveal the long-term outcome of standard surgical treatment and determine the predictive factors for pathological lymph node metastasis in optimal candidates undergoing limited surgical resection for pure-solid, small-sized lung adenocarcinoma.

Methods

The medical records of 107 consecutive patients were retrospectively reviewed at our hospital between December 2002 and December 2013. Inclusion criteria were histopathological diagnosis of lung adenocarcinoma, radiographically pure-solid tumor, ≤ 2 cm tumor size measured using thin-section computed tomography, clinical N0M0, patients who underwent lobectomy with systematic or lobe-specific lymph node dissection, and R0 resection. Overall and disease-free survival curves were calculated using the Kaplan–Meier method. Clinicopathological factors predicting pathological node-positive metastasis were identified by univariate and multivariate analysis.

Results

The 5-year overall and disease-free survival rates were 91.4% and 87.3%, respectively. Multivariate analysis demonstrated maximum standardized uptake value > 5 as the independent predictor of pathological node-positive metastasis (odds ratio 3.81; 95% confidence interval 1.25–12.3; p = 0.02). In all patients, the pathological node-positive rate was 16.7%; in patients who had a maximum standardized uptake value of ≤ 5, the rate was 7.9%.

Conclusion

The long-term outcome of standard surgical treatment was favorable. Maximum standardized uptake value was a significant predictor of pathological node-positive metastasis; however, diagnostic accuracy was not favorable. Therefore, the selection of optimal candidates is difficult, and limited surgical resection may not be applicable in pure-solid, small-sized lung adenocarcinoma.

Keywords

Pure-solid tumor, small-sized lung adenocarcinoma Positron emission tomography Maximum standardized uptake value Limited resection 

Notes

Compliance with ethical standards

Conflict of interest

The authors, Hiroyuki Kayata, Mitsuhiro Isaka, Yukihiro Terada, Kiyomichi Mizuno, Yoshiyuki Yasuura, Hideaki Kojima, Yasuhisa Ohde, have no conflicts of interest to declare.

Supplementary material

11748_2018_1059_MOESM1_ESM.docx (21 kb)
Supplementary material 1 (DOCX 21 kb)

References

  1. 1.
    National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365:395–409.CrossRefGoogle Scholar
  2. 2.
    Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Masuda M, Endo S, Natsugoe S, Shimizu H, et al. Thoracic and cardiovascular surgery in Japan during 2015: annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2018.  https://doi.org/10.1007/s11748-018-0968-0.Google Scholar
  3. 3.
    Travis WD, Asamura H, Bankier AA, Beasley MB, Detterbeck F, Flieder DB, et al. The IASLC lung cancer staging project: proposals for coding T categories for subsolid nodules and assessment of tumor size in part-solid tumors in the forthcoming eight edition of the TNM classification of lung cancer. J Thorac Oncol. 2016;11:1204–23.CrossRefGoogle Scholar
  4. 4.
    Suzuki K, Koike T, Asakawa T, Kusumoto M, Asamura H, Nagai K, et al. Japan Lung Cancer Surgical Study Group (JCOG LCSSG). 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.CrossRefGoogle Scholar
  5. 5.
    Hattori A, Matsunaga T, Takamochi K, Oh S, Suzuki K. Neither Maximum tumor size nor solid component size is prognostic in part-solid lung cancer: impact of tumor size should be applied exclusively to solid lung cancer. Ann Thorac Surg. 2016;102:407–15.CrossRefGoogle Scholar
  6. 6.
    Tsutani Y, Miyata Y, Nakayama H, Okumura S, Adachi S, Yoshimura M, et al. Appropriate sublobar resection choice for ground glass opacity-dominant clinical stage IA lung adenocarcinoma: wedge resection or segmentectomy. Chest. 2014;145:66–71.CrossRefGoogle Scholar
  7. 7.
    Tsutani Y, Miyata Y, Nakayama H, Okumura S, Adachi S, Yoshimura M, et al. Segmentectomy for clinical stage IA lung adenocarcinoma showing solid dominance on radiology. Eur J Cardiothorac Surg. 2014;46:637–42.CrossRefGoogle Scholar
  8. 8.
    Wilshire CL, Louie BE, Manning KA, Horton MP, Castiglioni M, Gorden JA, et al. Radiologic evaluation of small lepidic adenocarcinomas to guide decision making in surgical resection. Ann Thorac Surg. 2015;100:979–88.CrossRefGoogle Scholar
  9. 9.
    Inoue M, Minami M, Sawabata N, Utsumi T, Kadota Y, Shigemura N, et al. Clinical outcome of resected solid-type small-sized c-stage IA non-small cell lung cancer. Eur J Cardiothorac Surg. 2010;37:1445–9.CrossRefGoogle Scholar
  10. 10.
    Hattori A, Suzuki K, Matsunaga T, Fukui M, Kitamura Y, Miyasaka Y, et al. Is limited resection appropriate for radiologically “solid” tumors in small lung cancers? Ann Thorac Surg. 2012;94:212–5.CrossRefGoogle Scholar
  11. 11.
    Kudo Y, Matsubayashi J, Saji H, Akata S, Shimada Y, Kato Y, et al. Association between high-resolution computed tomography findings and the IASLC/ATS/ERS classification of small lung adenocarcinomas in Japanese patients. Lung Cancer. 2015;90:47–54.CrossRefGoogle Scholar
  12. 12.
    Okada M, Yoshikawa K, Hatta T, Tsubota N. Is segmentectomy with lymph node assessment an alternative to lobectomy for non-small-cell lung cancer of 2 cm or smaller? Ann Thorac Surg. 2001;71:956–61.CrossRefGoogle Scholar
  13. 13.
    Yoshikawa K, Tsubota N, Kodama K, Ayabe H, Taki T, Mori T. Prospective study of extended segmentectomy for small lung tumors: the final report. Ann Thorac Surg. 2002;73:1055–9.CrossRefGoogle Scholar
  14. 14.
    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.CrossRefGoogle Scholar
  15. 15.
    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.CrossRefGoogle Scholar
  16. 16.
    Dai C, Shen J, Ren Y, Zhong S, Zheng H, He J, et al. Choice of surgical procedure for patients with Non-small-cell lung cancer ≤ 1 cm or > 1 to 2 cm among lobectomy, segmentectomy, and wedge resection: a population-based study. J Clin Oncol. 2016;34:3175–82.CrossRefGoogle Scholar
  17. 17.
    Khullar OV, Liu Y, Gillespie T, Higgins KA, Ramalingam S, Lipscomb J, et al. Survival after sublobar resection versus lobectomy for clinical stage IA lung cancer. An analysis from the national cancer data base. J Thorac Oncol. 2015;10:1625–33.CrossRefGoogle Scholar
  18. 18.
    Kates M, Swanson S, Wisnivesky JP. Survival following lobectomy and limited resection for the treatment of stage I non-small cell lung cancer ≤ 1 cm in size. A review of SEER data. Chest. 2011;139:491–6.CrossRefGoogle Scholar
  19. 19.
    Cao C, Chandrakumar D, Gupta S, Yan TD, Tian DH. Could less or be more? –A systematic review and meta-analysis of sublobar resections versus lobectomy for non-small cell lung cancer according to patient selection. Lung Cancer. 2015;89:121–32.CrossRefGoogle Scholar
  20. 20.
    Nakamura K, Saji H, Nakajima R, Okada M, Asamura H, Shibata T, et al. A phase III randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). Jpn J Clin Oncol. 2010;40:271–4.CrossRefGoogle Scholar
  21. 21.
    Altorki N, Pass H, Miller D, Kernstine K, et al. A phase III randomized trial of lobectomy versus sublobar resection for small (≤ 2 cm) peripheral non-small cell lung cancer. https://clinicaltrials.gov/. Accessed 9 May 2018.
  22. 22.
    Tsutani Y, Miyata Y, Nakayama H, Okumura S, Adachi S, Yoshimura M, et al. Prediction of pathologic node-negative clinical stage IA lung adenocarcinoma for optimal candidates undergoing sublobar resection. J Thorac Cardiovasc Surg. 2012;144:1365–71.CrossRefGoogle Scholar
  23. 23.
    Ye B, Cheng M, Li W, Ge XX, Geng JF, Feng J, et al. Predictive factors for lymph node metastasis in clinical stage IA lung adenocarcinoma. Ann Thorac Surg. 2014;98:217–23.CrossRefGoogle Scholar
  24. 24.
    Moon Y, Kim KS, Lee KY, Sung SW, Kim YK, Park JK. Clinicopathologic factors associated with occult lymph node metastasis in patients with clinically diagnosed N0 lung adenocarcinoma. Ann Thorac Surg. 2016;101:1928–35.CrossRefGoogle Scholar
  25. 25.
    Zhang J, Chen L, Chen Y, Wang W, Cheng L, Zhou X, et al. Tumor vascularity and glucose metabolism correlated in adenocarcinoma, but not in squamous cell carcinoma of the lung. PLoS ONE. 2014;9:e91649.CrossRefGoogle Scholar
  26. 26.
    Tsutani Y, Miyata Y, Misumi K, Ikeda T, Mimura T, Hihara J, et al. Difference in prognostic significance of maximum standardized uptake value on [18F]-Fluoro-2-Deoxyglucose positron emission tomography between adenocarcinoma and squamous cell carcinoma of the lung. Jpn J Clin Oncol. 2011;41:890–6.CrossRefGoogle Scholar
  27. 27.
    Rena O, Boldorini R, Papalia E, Turello D, Massera F, Davoli F, et al. Metastasis to subsegmental and segmental lymph nodes in patients resected for non-small cell lung cancer: prognostic impact. Ann Thorac Surg. 2014;97:987–92.CrossRefGoogle Scholar
  28. 28.
    Yamanaka A, Hirai T, Fujimoto T, Ohtake Y, Konichi F. Analyses of segmental lymph node metastases and intrapulmonary metastases of small lung cancer. Ann Thorac Surg. 2000;70:1624–8.CrossRefGoogle Scholar
  29. 29.
    Wang L, Jiang W, Zhan C, Shi Y, Zhang Y, Lin Z, et al. Lymph node metastasis in clinical stage IA peripheral lung cancer. Lung Cancer. 2015;90:41–6.CrossRefGoogle Scholar
  30. 30.
    Okada M, Nakayama H, Okumura S, Daisaki H, Adachi S, Yoshimura M, et al. Multicenter analysis of high-resolution computed tomography and positron emission tomography/computed tomography findings to choose therapeutic strategies for clinical stage IA lung adenocarcinoma. J Thorac Cardiovasc Surg. 2011;141:1384–91.CrossRefGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2019

Authors and Affiliations

  1. 1.Division of General Thoracic SurgeryShizuoka Cancer CenterShizuokaJapan

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