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Surgical strategies for patients with second primary non-small cell lung cancer lesions 2 cm or less in diameter
Zhile Wang1,2, Yijun Wu1,2, Jing Huang2
1Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
Background And Purpose:
The wide application of low-dose computed tomography (CT) has led to an increase in the detection of small lung cancer lesions. Moreover, surgical recommendations for second primary non-small cell lung cancer (NSCLC) lesions ≤ 2 cm are obscure. This study compares the efficacy of wedge resection, lobectomy, and segmentectomy for small second primary NSCLC lesions.
Methods:
The cohort was established based on the SEER database. Univariate and multivariate cox regression analysis, least absolute shrinkage and selection operator (LASSO) regression, and restricted mean survival time (RMST) values were applied to identify prognostic factors. We used the Kaplan-Meier method to plot the survival curves of the different subgroups according to propensity score matching (PSM) analysis to then compare the therapeutic efficacy of the surgical procedures.
Results:
A total of 568 patients were enrolled in this study. Age, sex, grade, and lymph node ratio were selected as independent prognostic factors (p < 0.05). No significant differences were observed in survival probabilities among the groups of patients who underwent segmentectomy, wedge resection, or lobectomy (p > 0.05). We also established a nomogram model based on the four prognostic factors to guide clinical treatment.
Conclusions:
Based on the findings of our study, segmentectomy was more appropriate than lobectomy for patients with a second primary NSCLC lesion ≤ 2 cm in diameter. The evidence to support other recommendations is insufficient.
Insights
Segmentectomy may be more suitable than lobectomy for small second primary non-small cell lung cancer (NSCLC) lesions. This study found no significant survival differences between segmentectomy, wedge resection, and lobectomy for these small tumors.
Area of Science:
- Thoracic Surgery
- Oncology
- Pulmonary Medicine
Background:
- Low-dose computed tomography (CT) increases detection of small lung cancer.
- Surgical guidelines for second primary non-small cell lung cancer (NSCLC) lesions ≤2 cm are unclear.
Purpose of the Study:
- Compare surgical efficacy for small second primary NSCLC lesions.
- Evaluate wedge resection, lobectomy, and segmentectomy outcomes.
Main Methods:
- Utilized SEER database for cohort establishment.
- Applied Cox regression, LASSO, and RMST for prognostic factor identification.
- Used Kaplan-Meier and propensity score matching (PSM) for survival analysis.
Main Results:
- Identified age, sex, grade, and lymph node ratio as independent prognostic factors.
- No significant survival differences observed among segmentectomy, wedge resection, and lobectomy groups.
- Developed a nomogram model for clinical guidance.
Conclusions:
- Segmentectomy appears more appropriate than lobectomy for NSCLC lesions ≤2 cm.
- Insufficient evidence currently supports other specific surgical recommendations for these cases.
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