末梢小型非小細胞肺癌に対する亜葉切除の実現可能性と断端陰性率に関連する因子

This study aimed to identify factors associated with the feasibility and margin quality of sublobar resection for peripheral small-sized non-small cell lung cancer (NSCLC).

Patients with peripheral small-sized non-small cell lung cancer (≤2 cm) who underwent sublobar resection or lobectomy between 2020 and 2023 were screened. Surgical procedures were determined through discussion under the guidance of 3-dimensional computed tomography bronchography and angiography. A surgical margin equal to or larger than the maximum tumor diameter was considered sufficient. Logistic regression analyses were used to screen factors associated with the feasibility and margin quality of sublobar resection. Predictive nomograms were developed for segmentectomy and wedge based on independent factors, respectively.

There were 383 (51.3%), 286 (38.3%), and 78 patients (10.4%) undergoing wedge resection, segmentectomy, and lobectomy, respectively. The likelihood of achieving sufficient margins was 90.9% for segmentectomy and 74.4% for wedge resection. Overall, 545 of 747 patients (73.0%) received sublobar resection with sufficient margins. The multivariable logistic regression analysis (segmentectomy with insufficient margins or lobectomy = 1, segmentectomy with sufficient margins = 0) showed that tumor size, radiologic types, located lobes, tumor-to-segmental bronchus distance, and subsegmental attribution were significantly associated with the feasibility and margin quality of segmentectomy. For wedge resection, tumor size and Lewis types were significantly associated with its feasibility or margin quality. The predictive models exhibited good performance, with an area under the curve of 0.821 for segmentectomy and 0.765 for wedge resection.

Tumor size, radiologic types, located lobe, tumor-to-segmental bronchus distance, Lewis types, and subsegmental attribution types were associated with the feasibility and margin quality of sublobar resection.