Oncologic outcomes of segmentectomy compared with lobectomy for clinical stage IA lung adenocarcinoma: propensity score-matched analysis in a multicenter study

Yasuhiro Tsutani; Yoshihiro Miyata; Haruhiko Nakayama; Sakae Okumura; Shuji Adachi; Masahiro Yoshimura; Morihito Okada

doi:10.1016/j.jtcvs.2013.02.008

Oncologic outcomes of segmentectomy compared with lobectomy for clinical stage IA lung adenocarcinoma: propensity score-matched analysis in a multicenter study

J Thorac Cardiovasc Surg. 2013 Aug;146(2):358-64. doi: 10.1016/j.jtcvs.2013.02.008. Epub 2013 Mar 8.

Authors

Yasuhiro Tsutani¹, Yoshihiro Miyata, Haruhiko Nakayama, Sakae Okumura, Shuji Adachi, Masahiro Yoshimura, Morihito Okada

Affiliation

¹ Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.

PMID: 23477694
DOI: 10.1016/j.jtcvs.2013.02.008

Abstract

Objective: Our objective was to compare the oncologic outcomes of lobectomy and segmentectomy for clinical stage IA lung adenocarcinoma.

Methods: We examined 481 of 618 consecutive patients with clinical stage IA lung adenocarcinoma who underwent lobectomy or segmentectomy after preoperative high-resolution computed tomography and F-18-fluorodeoxyglucose positron emission tomography/computed tomography. Patients (n = 137) who underwent wedge resection were excluded. Lobectomy (n = 383) and segmentectomy (n = 98) as well as surgical results were analyzed for all patients and their propensity score-matched pairs.

Results: Recurrence-free survival (RFS) and overall survival (OS) were not significantly different between patients undergoing lobectomy (3-year RFS, 87.3%; 3-year OS, 94.1%) and segmentectomy (3-year RFS, 91.4%; hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.27-1.20; P = .14; 3-year OS, 96.9%; HR, 0.49; 95% CI, 0.17-1.38; P = .18). Significant differences in clinical factors such as solid tumor size (P < .001), maximum standardized uptake value (SUVmax) (P < .001), and tumor location (side, P = .005; lobe, P = .001) were observed between both treatment groups. In 81 propensity score-matched pairs including variables such as age, gender, solid tumor size, SUVmax, side, and lobe, RFS and OS were similar between patients undergoing lobectomy (3-year RFS, 92.9%, 3-year OS, 93.2%) and segmentectomy (3-year RFS, 90.9%; 3-year OS, 95.7%).

Conclusions: Segmentectomy is suitable for clinical stage IA lung adenocarcinoma, with survivals equivalent to those of standard lobectomy.

Keywords: 10; CI; FDG-PET/CT; GGO; HRCT; NSCLC; OS; RFS; SUVmax; [18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography; confidence interval; ground-glass opacity; high-resolution computed tomography; maximum standardized uptake value; non–small cell lung cancer; overall survival; recurrence-free survival.

Publication types

Comparative Study
Multicenter Study

MeSH terms

Adenocarcinoma / diagnostic imaging
Adenocarcinoma / mortality
Adenocarcinoma / secondary
Adenocarcinoma / surgery*
Adenocarcinoma of Lung
Adult
Aged
Aged, 80 and over
Chi-Square Distribution
Disease-Free Survival
Female
Fluorodeoxyglucose F18
Humans
Japan
Kaplan-Meier Estimate
Logistic Models
Lung Neoplasms / diagnostic imaging
Lung Neoplasms / mortality
Lung Neoplasms / pathology
Lung Neoplasms / surgery*
Lymphatic Metastasis
Male
Middle Aged
Multidetector Computed Tomography
Multimodal Imaging
Neoplasm Recurrence, Local
Neoplasm Staging
Patient Selection
Pneumonectomy / adverse effects
Pneumonectomy / methods*
Pneumonectomy / mortality
Positron-Emission Tomography
Predictive Value of Tests
Propensity Score
Proportional Hazards Models
Radiopharmaceuticals
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Tumor Burden

Substances

Radiopharmaceuticals
Fluorodeoxyglucose F18