Adaptation criterion for segmentectomy in small-sized early stage non-small cell lung cancer

Although the utility of segmentectomy for early-stage non-small cell lung cancer (NSCLC) has been reported, the adaptation criterion for segmentectomy is unclear.

In total, 171 NSCLC patients who underwent segmentectomy or lobectomy with a consolidation tumor diameter on computed tomography of ≤20 mm were analyzed.

Consolidation diameter (p = 0.01), consolidation to tumor ratio (CTR) (p < 0.01), maximum standardized uptake value (SUV_max ) (p < 0.01), and segmentectomy (p = 0.01) were significantly different upon univariate analysis among patients stratified by recurrence. Positive correlations were observed between the consolidation diameter on CT and CEA (correlation coefficient; r = 0.19, p = 0.01), SUV_max (r = 0.48, p < 0.01), and CTR (r = 0.83, p < 0.01). Because there was a significant correlation among the consolidation diameter of tumors on CT, CTR, and SUV_max in this study, we integrated these factors into one. Consolidation, CTR, and SUV_max (hazard ratio [HR]: 3.77, 95% confidence interval [CI]: 1.35-11.29, p = 0.01) and segmentectomy (HR: 0.24, 95% CI: 0.03-0.90, p = 0.03) were risk factors for recurrence in a multivariate analysis. There was a significant difference between the segmentectomy and lobectomy groups (5-year relapse-free survival [RFS] 96.5% vs. 80.7%, p = 0.02).

Consolidation tumor diameter on CT, CTR, and SUV_max is a risk factor for recurrence. These results suggest that for patients with small-sized early stage NSCLC, this combined factor is important for determining the indication for segmentectomy.