Risk Factors Associated With Locoregional Recurrence Following Pulmonary Segmentectomy for Clinical Stage IA1-2...

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Anatomic segmentectomy is increasingly used for early-stage non-small-cell lung cancer (NSCLC).
• Predictors of recurrence after segmentectomy require further elucidation to optimize patient outcomes.
• Understanding recurrence patterns is key to refining surgical strategies for NSCLC.

Purpose of the Study:

• To identify predictors of recurrence following segmentectomy in patients with clinical stage IA1-2 NSCLC.
• To evaluate the impact of resection margins, tumor characteristics, and patient factors on recurrence-free survival (EFS) and overall survival (OS).
• To inform surgical decision-making and preoperative planning for segmentectomy in early-stage NSCLC.

Main Methods:

• Retrospective analysis of 287 patients undergoing segmentectomy for clinical stage IA1-2 NSCLC (2017-2024).
• Assessment of event-free survival (EFS), overall survival (OS), and recurrence patterns.
• Application of Cox regression and competing risk models to identify factors associated with adverse outcomes.

Main Results:

• Four-year OS and EFS were 80% and 69.5%, respectively. Loco-regional recurrence was the predominant pattern (9.1%).
• Resection margins <5 mm were significantly associated with higher loco-regional recurrence rates (20.3% vs 5.8%, P<.001) and independently predicted recurrence (P=.009).
• Hypermetabolic tumors (PET SUVmax > 2.5) and pure solid tumors showed poorer EFS compared to less avid or subsolid tumors.

Conclusions:

• Adequate resection margins (≥5 mm) are critical for reducing loco-regional recurrence after segmentectomy in stage IA NSCLC.
• Positron emission tomography (PET) avidity and tumor morphology are important factors for stratifying recurrence risk.
• Tailored preoperative planning and surgical strategies are essential for achieving oncologically sound segmentectomies in early-stage NSCLC.