周一“星”视角|纵隔淋巴结清扫术在外周型临床IA期非小细胞肺癌肺段切除术中的应用；肺浸润性黏液腺癌与非黏液腺癌的预后比较

01

Hiroyuki Adachi¹, Hiroyuki Ito²,Takuya Nagashima²,Tetsuya Isaka², Kotaro Murakami², Shunsuke Shigefuku², Noritake Kikunishi², Naoko Shigeta², Yujin Kudo³, Yoshihiro Miyata⁴, Morihito Okada⁴, Norihiko Ikeda³

1 Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan.

2 Department of Surgery, Yokohama City University, Yokohama, Japan.

3 Department of Surgery, Tokyo Medical University, Tokyo, Japan.

4 Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.

Background：

The necessity of mediastinal lymph node dissection (MLND) in segmentectomy remains uncertain as recent trials on intentional segmentectomy have made MLND mandatory. We conducted a retrospective study to evaluate the necessity of MLND in segmentectomy for patients with peripheral stage IA (≤2 cm) non-small-cell lung cancer (NSCLC).

Methods：

Of the 5,222 surgical cases for NSCLC from three institutions between 2010 and 2021, 1,457 patients met the JCOG0802 trial eligibility criteria. Initially, we analyzed 574 patients who underwent lobectomy with MLND to identify preoperative risk factors for cN0-pN2 occurrence (Cohort 1). Subsequently, we evaluated the relationship between these factors and the cumulative postoperative recurrence in 390 patients who underwent segmentectomy (Cohort 2).

Results：

In Cohort 1, risk factors for cN0-pN2 occurrence were consolidation-to-tumor ratio (CTR) =1.0 and maximum standardized uptake value (SUVmax) ≥2.0. When classifying patients into three groups (Group A without any factors, Group B with either factor, and Group C with both factors), the cN0-pN2 occurrence was significantly higher in Group C than in the other groups (0.9%, 3.4%, and 8.4%, respectively, P =0.005). When classifying patients in Cohort 2 using the classification identified in Cohort 1 (117, 131, and 142 were categorized into Group A, Group B, and Group C, respectively), the 5-year cumulative incidence of recurrence rate was significantly higher in Group C than in others (2.0%, 2.0%, and 15.9%, respectively, P <0.001).

Conclusions:

MLND is unlikely to be beneficial in intentional segmentectomy for patients with tumors showing CTR < 1.0 and SUVmax < 2.0.

[CITATION]:Adachi H, Ito H, Nagashima T, et al. Mediastinal lymph node dissection in segmentectomy for peripheral c-stage IA (≤2 cm) non-small-cell lung cancer. J Thorac Cardiovasc Surg. 2024 Sep 9:S0022-5223(24)00786-4.

[DOI]:10.1016/j.jtcvs.2024.09.003.

[IF]: 4.9

02

Jun Oh Lee1, Geun Dong Lee1 , Sehoon Choi1 Hyeong Ryul Kim1, Yong-Hee Kim1 , Dong Kwan Kim1, Seung-Il Park1, Jae Kwang Yun1

1 Department of Thoracic and Cardiovascular Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Objectives: 

Invasive mucinous adenocarcinoma exhibits distinct prognostic outcomes compared to non-mucinous adenocarcinoma (ADC). This study investigated and compared the clinical outcomes and prognostic factors of invasive mucinous and non-mucinous ADC patients.

Methods: 

This retrospective study included patients who underwent curative surgery for ADC between 2011 and 2021. Patient characteristics were balanced using propensity score matching. Cumulative incidence was analysed to evaluate cancer recurrence incidence, and the Kaplan-Meier method was used to calculate overall survival (OS) for each group.

Results: 

A total of 6101 patients were included. After matching, the non-mucinous group and mucinous groups comprised 798 and 408 patients, respectively. The patients in the mucinous group had a lower recurrence incidence than those in the non-mucinous group (P = 0.014). The recurrence incidence in the mucinous group was between those of grades 1 (P = 0.011) and 2 (P = 0.012) and the OS rates were comparable to those of grades 2 (P = 0.6) and 3 (P = 0.2). Multivariable analysis revealed that the maximal standardized uptake value [hazard ratio (HR): 1.13, P = 0.11] and progressed pathological stages (pStage II, HR: 3.9, P = 0.028; pStage III, HR: 8.33, P = 0.038) served as adverse prognostic factors for the mucinous group.

Conclusions: 

Patients with mucinous ADC demonstrated lower recurrence incidence and similar OS rates compared to those with non-mucinous ADC. The recurrence incidence of mucinous ADC was between those of International Association for the Study of Lung Cancer grades 1 and 2, with the OS rates comparable to those of grades 2 and 3.

[CITATION]: Lee JO, Lee GD, Choi S, et al. Surgical prognosis of lung invasive mucinous and non-mucinous adenocarcinoma: propensity score matched analysis. Eur J Cardiothorac Surg. 2024 Sep 2;66(3):ezae316.

[DOI]: 10.1093/ejcts/ezae316. 

[IF]: 3.1