Surgical resection for clinical-Stage I radiological pure-solid lung cancer that met the current high risk criteria

We assessed whether surgical resection is acceptable for radiological invasive non-small cell lung cancer (NSCLC) that met the current high-risk criteria.

We reviewed 500 clinical-Stage I NSCLCs with a radiological pure-solid appearance. High-risk criterion was defined as follows: (1) preoperative FEV1% ≤ 50% or DLco% ≤ 50%, (2) age > 75y with 50% < FEV1% < 60% or 50% < DLco% < 60%, and (3) three or more severe general comorbidities.

The high-risk group comprised 184 (37%) patients. The percentages for elderly, male, smoker, non-adenocarcinoma histology were significantly higher than those of the normal-risk group (P < 0.001). Lobectomy was performed in 148 (80%) patients. Overall survival (OS) was significantly worse in the high-risk group (59.4% vs 73.1%, P = 0.004), however, a multivariate analysis revealed that high-risk was not associated with poor survival (P = 0.519). Furthermore, there were no significant differences between the high-risk and normal-risk groups regarding cancer-specific survival (74.5% vs 79.2%, P = 0.569). Postoperative morbidity rates were significantly different between the two study arms (45% vs 25%, P < 0.001), however, the 30-day and 90-day mortality rates for the high-risk group were 1.6% and 3.8%, respectively. In the high-risk patients, the difference in survival between lobectomy and sublobar resection was not significant (69.4% vs 78.6%, P = 0.716), and was also proven in the propensity-score matched patients (82.1% vs 76.0%, P = 0.623).

Conventional high-risk criteria are not always appropriate prognostic variables, and lung cancer specific survival or short-term mortalities for high-risk patients were fully acceptable. Surgical therapy including lobectomy should not be readily excluded from radical local management even when a patient meets the high-risk criteria.