Lobectomy Plus Lobe-specific Lymphadenectomy As the Minimum Standards of Curative Resection for Hypermetabolic Clinical Stage IA Non-small Cell Lung Cancer

Overview

Journal Transl Lung Cancer Res

Date 2025 Feb 17

PMID 39958228

Authors

Runze Li

Zhifei Li

Peng Li

Jianchuan Chen

Bin Qiu

Fengwei Tan

Qi Xue

Shugeng Gao

Jie He

Affiliations

Soon will be listed here.

Abstract

Background: The results of three modern randomized controlled trials have proved sublobar resection as an effective procedure for early-stage non-small cell lung cancer (NSCLC) up to 2 cm. We aimed to examine whether sublobar resection is oncologically feasible and what constitutes adequate lymph node assessment for hypermetabolic clinical stage IA (cIA) NSCLC.

Methods: A single-center retrospective study was conducted in 589 patients who underwent lobectomy (n=526) or sublobar resection (n=63) for hypermetabolic cIA NSCLC [maximum standardized uptake value (SUVmax) ≥2.6 g/dL]. The primary outcomes (lung cancer-specific death and tumor recurrence) were compared in a competing risks framework for all patients and the propensity score matched pairs. Random forests were used to examine the variable importance for lung cancer-specific survival and tumor recurrence. Factors affecting pathological upstaging and recurrence-free survival were assessed by logistic regression analysis and Cox regression analysis, respectively.

Results: Sublobar resection had significantly higher lung cancer-specific cumulative incidence of death (LC-CID) and cumulative incidence of recurrence (CIR) than lobectomy after matching (5-year LC-CID, 20.8% . 6.5%, P<0.001; 5-year CIR, 37.9% . 14.8%, P<0.001). Wedge resection was an independent risk factor for both lung-cancer specific death [hazard ratio (HR) =4.17; 95% confidence interval (CI): 2.07-8.36; P<0.001] and recurrence (HR =3.48; 95% CI: 1.91-6.33; P<0.001). Lymphadenectomy that failed to meet the lobe-specific nodal dissection (LSND) criteria correlated with decreased odds of pathological nodal upstaging [odds ratio (OR) =0.55; 95% CI: 0.34-0.87; P=0.01]. While patients with LSND had lower LC-CIR and CIR, there was no additional prognostic benefit of systemic nodal dissection (SND) over LSND.

Conclusions: Lobectomy was oncologically superior to sublobar resection as a curative-intent procedure for hypermetabolic cIA NSCLC. Lobectomy plus lobe-specific lymphadenectomy should be considered as the minimum standards of curative resection for hypermetabolic early-stage NSCLC in order to achieve more accurate pathological N staging and better cancer control.

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