Treatment of Unsuspected T4 Non-Small Cell Lung Cancer With Additional Intrapulmonary Nodules

There is limited consensus on the optimal treatment for patients with non-small cell lung cancer (NSCLC) who are found to have additional intrapulmonary nodules in a different ipsilateral lobe (unsuspected pT4-Add) during surgical intervention. This study compared outcomes of patients with unsuspected pT4-Add NSCLC after resection of the primary site tumor with or without resection of additional nodules.

Patients who underwent surgical intervention for cT1-3 N0-1 M0 NSCLC with unsuspected pT4-Add disease in the National Cancer Database (2010-2015) were included. Overall survival and short-term outcomes were compared between patients who underwent resection of only the primary tumor ("primary site resection") and those who underwent resection of the primary tumor and additional nodules ("extended resection)" by using Kaplan-Meier analysis and propensity score matching on 10 variables.

Of the 339 patients included in this study, 245 (72.3%) underwent primary site resection and 94 (27.7%) underwent extended resection. In a 2:1 variable ratio propensity score-matched analysis of 83 patients who underwent primary site resection and 42 patients who underwent extended resection, no significant difference was found in 5-year overall survival between the 2 groups.

The results of this national analysis suggest that in the setting of unsuspected pT4-Add NSCLC, proceeding without resection of additional nodules may confer similar overall survival for carefully selected patients with appropriate adjuvant therapy.