本期胸小星将为大家带来CALGB140503:亚肺叶切缘距与预后关系；JCOG0802/WJOG4607L:肺段切除术后局部复发因素，一起来看看吧！
2017·EATTS
01
L.W. Martin1, C-F. Yang2, X. Wang3, B. Damman4, T.E. Stinchcombe3, J. Mentlick4, R. Landreneau5, D. Wigle4, D.R. Jones6, M. Conti7, A.S. Ashrafi8, M. Liberman9, M. de Perrot10, J.D. Mitchell11, R. Keenan12, T. Bauer13, D. Miller14, N. Altorki15
1 University of Virginia, Charlottesville/VA/USA.
2 Massachusetts General Hospital, Boston/MA/USA.
3 Duke University, Durham/NC/USA.
4 Mayo Clinic, Rochester/MN/USA.
5 Tampa General Hospital, Tampa/FL/USA.
6 Memorial Sloan Kettering Cancer Center, New York/NY/USA.
7 Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec/QC/CA.
8 Surrey Memorial Hospital, Surrey/BC/CA.
9 Centre Hospitalier de l’Université de Montréal, Montreal/QC/CA.
10 University of Toronto, Toronto/ON/CA.
11 University of Colorado, Aurora/CO/USA.
12 Moffitt Cancer Center, Tampa/FL/USA .
13 Hackensack Meridian Health Center, Hackensack/NJ/USA.
14 Emory University, Atlanta/GE.
15 Weill Cornell Medicine, New York/NY/USA.
Background:
In a randomized trial of lobectomy vs sublobar resection (CALGB 140503, NCT00499330) for stage IA (<2cm) lung cancer, sublobar resection was non-inferior to lobectomy for the primary endpoint of disease-free survival (DFS), and secondary endpoint of locoregional recurrence. Despite this, questions remain about adequacy of local control with sublobar resection. In this post-hoc analysis, we evaluate the association between surgical margin distance (SMD) and locoregional-recurrence-free survival (LRFS) and overall survival (OS) within the cohort undergoing sublobar resection.
Methods:
Patients who underwent sublobar resection for cT1a-bN0 NSCLC in CALGB 140503 were grouped by presence or absence of locoregional recurrence [LRR]. The SMD, as determined by the operating surgeon, and the ratio between the SMD and tumor size (“margin-to-tumor size ratio”) were evaluated. Multivariable Cox proportional hazards modeling was used to evaluate association between SMD and LRFS, OS. The association between margin-to-tumor size ratio and LRFS, OS was similarly analyzed. Patients who died within 90-days of surgery, and patients lost to follow-up were excluded from this analysis.
Results:
A total of 329 evaluable patients underwent sublobar resection (201 [61.1%] wedge resection, 128 [37.9%] segmentectomy), of whom 45 (13.7%) developed a LRR during a median follow-up of 7 years. Of these patients, 208 (135 [64.9%] wedge resection, 73 [35.1%] segmentectomy) had known SMD data, of which 29 (13.9%) experienced LRR. There were no significant differences in SMD between patients who did and did not have a LRR (mean SMD in cm [SD]: 1.9 [1.46] vs. 2.0 [1.19], P = 0.33). Margin-to-tumor size ratio was similar between patients with and without LRR (mean [SD]: 1.2 [1.0] vs. 1.5 [1.0], P = 0.11). There were no independent predictors of LRFS (Figure 1). Tumor size >1.5 cm (aHR: 2.11: 95%CI: 0.96- 4.66, P = 0.06) and margin-to-tumor size ratio <1 (aHR: 2.12: 95% CI: 0.69 - 6.94, P = 0.19) trended towards but did not achieve statistical significance. There was no association between SMD nor margin-to-tumor size ratio and OS.
Conclusion: In this analysis of the sublobar resection cohort in CALGB 140503, 13.7% experienced LRR. Surprisingly, neither SMD nor margin-to-tumor size ratio were predictive of LRFS or OS.
[CITATION]: L.W. Martin, C.-F. Yang, X. Wang, et al. MA03.10 Association of Surgical Margin Distance, Locoregional Recurrence, and Survival Among Patients Undergoing Sublobar Resection in CALGB140503. Journal of Thoracic Oncology. Volume 19, Issue 10, Supplement,2024,Pages S63-S64.
[DOI]: 10.1016/j.jtho.2024.09.114
[IF]: 21.0
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胸“星”外科学术团队成员 谭媛媛 译
背景
方法
结果
结论
Figure 1.
2017·EATTS
02
Risk factors for locoregional relapse after segmentectomy: Supplementary analysis of the JCOG0802/WJOG4607L trial
Kazuo Nakagawa1, Shun-Ichi Watanabe1, Masashi Wakabayashi2, Masaya Yotsukura1, Takahiro Mimae3, Aritoshi Hattori4, Tomohiro Miyoshi5, Mitsuhiro Isaka6, Makoto Endo7, Hiroshige Yoshioka8, Yasuhiro Tsutani9, Tetsuya Isaka10, Tomohiro Maniwa11, Ryu Nakajima12, Kenji Suzuki4, Keiju Aokage5, Hisashi Saji13, Masahiro Tsuboi5, Morihito Okada3, Hisao Asamura14, Yuta Sekino2, Kenichi Nakamura2, Haruhiko Fukuda2
1 Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan.
2 JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan.
3 Department of Surgical Oncology, Hiroshima University Hospital, Hiroshima, Japan.
4 Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
5 Division of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan.
6 Department of Thoracic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
7 Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan.
8 Department of Thoracic Oncology, Kansai Medical University Hospital, Osaka, Japan.
9 Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
10 Department of Thoracic Surgery, Kanagawa Cancer Center, Kanagawa, Japan.
11 Department of Thoracic Surgery, Osaka International Cancer Institute, Osaka, Japan.
12 Department of General Thoracic Surgery, Osaka City General Hospital, Osaka, Japan.
13 Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
14 Division of Thoracic Surgery, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan.
Introduction:
The JCOG0802/WJOG4607L trial revealed superior overall survival in segmentectomy to lobectomy for small-peripheral non-small-cell lung cancer. However, locoregional relapse (LR) is a major issue for segmentectomy. An ad hoc supplementary analysis aimed to determine the risk factors for LR and the degree of advantages of segmentectomy based on primary tumor sites.
Methods:
Participants in multi-institutional and intergroup, open-label, phase 3 randomized controlled trial in Japan were enrolled from August 10, 2009, to October 21, 2014. Risk factors for LR after segmentectomy and clinical features following the primary tumor site were investigated.
Results:
Of 1105 patients, 576 and 529 underwent lobectomy and segmentectomy, respectively. The primary tumor site for segmentectomy was the left upper division, left lingular segment, left S6, left basal segment, right upper lobe, right S6, or right basal segment. Multivariable analysis in the segmentectomy group revealed that pure-solid appearance on thin-section computed tomography (odds ratio 3.230; 95% confidential interval [CI] 1.559–6.690; P = 0.0016), margin distance less than the tumor size (odds ratio 2.682; 95% CI 1.350–5.331; P = 0.0049), and male sex (odds ratio: 2.089; 95% CI: 1.047–4.169; P = 0.0366) were significantly associated with LR. Patients with left lingular segment tumors (odds ratio 4.815; 95% CI 1.580– 14.672) tended to experience LR more frequently than those with left upper division tumors, although primary tumor sites were not statistically significant.
Conclusions:
Thin-section computed tomography findings and margin distance are important factors to avoid LR in segmentectomy.
[CITATION]: Nakagawa K, Watanabe SI, Wakabayashi M, et al. Risk factors for locoregional relapse after segmentectomy: Supplementary analysis of the JCOG0802/WJOG4607L trial. J Thorac Oncol. 2024 Oct 10:S1556-0864(24)02376-1.
[DOI]: 10.1016/j.jtho.2024.10.002.
[IF]: 21.0
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肺段切除术后局部区域复发的危险因素：JCOG0802/WJOG4607L试验的补充分析
胸“星”外科学术团队成员 邓婷 译
背景
方法
结果
结论
Table 2. Univariable and Multivariable Analyses to Identify Risk Factors for Locoregional Relapse in the Segmentectomy Group
LR, locoregional relapse; CI, confidence interval.
Table 4. Details of 11 Patients with Locoregional Relapse at the Surgical Margin after Segmentectomy
CTR, consolidation-to-tumor ratio; Ad, adenocarcinoma; ly, lymphatic invasion; v, vascular invasion; pl, pleural invasion; WD, well differentiated; MD, moderately differentiated; PD, poorly differentiated.
2017·EATTS
