Oncologic outcomes after minimally invasive segmentectomy or lobectomy in patients with hypermetabolic clinical stage IA1-2 non-small cell lung cancer.

Brunelli, A.; Lodhia, J.; Milton, R.; Nardini, M.; Papagiannopoulos, K.; Tcherveniakov, P.; Stefanou, D.; Teh, E.; Chaudhuri, N.

Oncologic outcomes after minimally invasive segmentectomy or lobectomy in patients with hypermetabolic clinical stage IA1-2 non-small cell lung cancer.

All Authors

Brunelli, A.

Lodhia, J.

Milton, R.

Nardini, M.

Papagiannopoulos, K.

Tcherveniakov, P.

Stefanou, D.

Teh, E.

Chaudhuri, N.

LTHT Author

Brunelli, Alessandro
Brunelli, Alessandro
Lodhia, Joshil
Milton, Richard
Nardini, Marco
Papagiannopoulos, Kostas
Tcherveniakov, Peter
Stefanou, Demetrios
Teh, Elaine
Chaudhuri, Nilanjan

LTHT Department

Thoracic Surgery

Publication Date

2024

Item Type

Journal Article

Abstract

Objective: To evaluate the oncologic outcome of patients with hypermetabolic tumors resected by segmentectomy or lobectomy. Methods: This was a retrospective analysis of all consecutive patients with peripheral clinical stage IA1-2 non-small cell lung cancer (January 2017-June 2023) who underwent resection by segmentectomy or lobectomy in a single center. A hypermetabolic tumor was defined as a tumor with a positron emission tomography (PET) maximum standardized uptake value >2.5. Propensity score case-matching analysis was used to generate 2 balanced groups of patients with hypermetabolic tumors operated by segmentectomy or lobectomy. Four-year overall survival (OS), event-free survival (EFS), and cancer-specific survival were compared between the matched groups. Results: A total of 164 segmentectomies and 234 lobectomies were analyzed. There were 91 (55%) hypermetabolic tumors in the segmentectomy group versus 178 in the lobectomy group (76%), P < .001. The comparison of the matched groups with hypermetabolic tumors showed a better 4-year OS after lobectomy compared with segmentectomy (lobectomy 87%; 95% confidence interval [CI], 76-93; segmentectomy, 67%; 95% CI, 49-80; P = .029). The 4-year EFS appeared to have a better trend after lobectomy (77%; 95% CI, 65-85) compared with segmentectomy (58%; 95% CI, 39-72), P = .088. The 4-year cancer-specific survival, however, was similar between the matched groups (lobectomy, 95%; 95% CI, 86-98 vs segmentectomy, 94%; 95% CI, 78-99, P = .79). Conclusions: Early-stage peripheral hypermetabolic tumors are associated with poorer oncologic outcomes compared with less PET-avid tumors. Despite poorer OS and EFS after segmentectomy likely caused by cancer-unrelated deaths, cancer-specific survival in this high-risk group was similar after lobectomy or segmentectomy. In well-selected patients, a high PET maximum standardized uptake value should not be considered a contraindication to segmentectomy.