Indications for segmentectomy in early-stage lung cancer based on solid volume analysis using three-dimensional...

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Diagnostic Imaging

Background:

• Segmentectomy is increasingly indicated for small lung cancers, necessitating precise preoperative evaluation.
• Objective measurement techniques are crucial for irregularly shaped tumors.
• Accurate assessment of tumor characteristics preoperatively is vital for surgical planning.

Purpose of the Study:

• To assess novel segmentectomy criteria for early-stage non-small-cell lung cancer (NSCLC) using three-dimensional (3D) CT tumor volume.
• To evaluate the predictive value of solid component volume and ratio for recurrence and mortality.
• To stratify patients based on tumor volume and solid component ratio for survival analysis.

Main Methods:

• Retrospective analysis of 200 segmentectomies and 691 lobectomies for clinical stage 0/IA NSCLC.
• Preoperative 3D-CT was used to measure total tumor volume and solid component volume.
• Receiver operating characteristic (ROC) curves determined cut-off values; patients were stratified into four risk categories.

Main Results:

• Cut-off values for segmentectomy were 2063.4 mm³ (volume) and 28.3% (ratio); for lobectomy, they were 4705.0 mm³ and 73.0%.
• A significant difference in 5-year recurrence-free survival was observed only in the "volume high risk + ratio high risk" category (48.1% vs. 66.9%).
• This highlights the prognostic significance of tumor volume and solid component ratio.

Conclusions:

• Three-dimensional CT tumor quantification shows potential for refining segmentectomy criteria in early-stage NSCLC.
• The proposed criteria may help differentiate between surgical approaches based on tumor characteristics.
• External validation is required prior to widespread clinical adoption.