Segmentectomy versus lobectomy for solid predominant cN0 lung cancer: analysis using visual evaluation of positron emission tomography.

Abstract

OBJECTIVES:

Prognosis after segmentectomy for early-stage non-small cell lung cancer (NSCLC) with a high consolidation tumour ratio (CTR) and [18F]-fluoro-2-deoxy-d-glucose (FDG) accumulation on positron emission tomography/computed tomography is unclear.

METHODS:

Participants of this study were 465 patients who underwent lobectomy or segmentectomy for clinical N0 NSCLC presenting solid component predominant tumour (CTR >50%) with a whole size ≤3 cm. Accumulations of FDG on positron emission tomography/computed tomography scans were scored according to the Deauville criteria, a 5-point visual evaluating method (Deauville score). The correlations between Deauville score, prognosis, and procedures were analysed.

RESULTS:

Characteristics of pathological invasiveness, such as lymphatic invasion (P < 0.001), vascular invasion (P < 0.001) and pleural invasion (P < 0.001), and non-adenocarcinoma histologies (P < 0.001) were more common in patients with Deauville scores of 3-5. The cumulative incidence of recurrence (CIR) was higher in patients with Deauville scores of 3-5 (P < 0.001). The CIR after lobectomy and segmentectomy did not differ significantly among patients with Deauville scores of 1 or 2 (P = 0.598) or those with Deauville scores of 3-5 (P = 0.322). In the analysis of propensity score matched cohort, the CIR after lobectomy and segmentectomy did not differ significantly between patients with Deauville scores of 1 or 2 and Deauville scores of 3-5.

CONCLUSIONS:

Segmentectomy may be feasible for NSCLC with high CTR (>50%) and accumulation of FDG. This finding should be confirmed in larger prospective studies.

• Authors: Atsushi Kagimoto, Yasuhiro Tsutani, Takahiro Mimae, Yoshihiro Miyata, Morihito Okada
• Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (Eur J Cardiothorac Surg) Vol. 61 Issue 2 Pg. 279-286 (Jan 24 2022) ISSN: 1873-734X [Electronic] Germany
• PMID: 34647128 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Chemical References

• Fluorodeoxyglucose F18

Topics

• Carcinoma, Non-Small-Cell Lung (diagnostic imaging, pathology, surgery)
• Fluorodeoxyglucose F18
• Humans
• Lung Neoplasms (diagnostic imaging, pathology, surgery)
• Neoplasm Staging
• Pneumonectomy (methods)
• Positron Emission Tomography Computed Tomography (methods)
• Positron-Emission Tomography
• Prospective Studies
• Retrospective Studies