Risk factors of up-Stage and lymph node metastasis for clinical stage IA3 non-small cell lung cancer
Nozomu Motono1, Masahito Ishikawa1, Shun Iwai1
1Department of Thoracic Surgery, Kanazawa Medical University, Ishikawa, Japan.
Background:
Although segmentectomy has tended to be the choice of treatment for clinical stage (cStage) IA non-small cell lung cancer (NSCLC) patients with tumor diameter ≤20 mm, the validity of sublobar resection for early-stage NSCLC patients with tumor diameters of 20-30 mm is uncertain. In this study, we retrospectively evaluated risk factors that might predict up-Stage and lymph node metastasis in NSCLC patients with tumor diameter 20-30 mm who underwent pulmonary resection.
Methods:
Overall, 410 patients with cStage IA disease, including 108 with cStage IA3, were enrolled in this retrospective study, and the risk factors of recurrence, up-Stage, and lymph node metastasis were analyzed.
Results:
The rates of patients with up-Stage (53.7% vs. 25.8%, P<0.01) and the presence of pathological lymph node metastasis (22.2% vs. 4.3%, P<0.01) were significantly higher for cStage IA3 patients. Relapse-free survival rates were significantly worse for cStage IA3 [5-year relapse-free survival: IA1 vs. IA2 =96.4% vs. 90.5%, IA1 vs. IA3 =96.4% vs. 66.1% (P<0.01), IA2 vs. IA3 =90.5% vs. 66.1% (P<0.01)]. For cStage IA3 NSCLC patients, multivariate analysis showed the cancer inflammation index [hazard ratio (HR): 3.21, P<0.01] and maximum standardized uptake value (HR: 2.64, P=0.03) were risk factors for postoperative recurrence; consolidation to tumor ratio (CTR) [odds ratio (OR): 5.88, P<0.01] and lymphatic invasion (Ly) (OR: 2.80, P=0.01) were risk factors for up-Stage; and the prognostic nutrition index (PNI) (OR: 25.51, P=0.02) and Ly (OR: 13.22, P<0.01) were risk factors for lymph node metastasis.
Conclusions:
The cancer inflammation index and maximum standardized uptake value were significant risk factors for recurrence, CTR and Ly were revealed to be risk factors for up-Stage, and PNI and Ly were risk factors for lymph node metastasis in cStage IA3 NSCLC patients. At present, the indication for segmentectomy should be carefully considered for cStage IA3 NSCLC patients with these risk factors.
