Unforeseen nodal upstaging in patients undergoing segmentectomy without frozen section: a multicenter retrospective cohort study.
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All Authors
Huang, L.
Brunelli, A.
Stefanou, D.
Zanfrini, E.
Donlagic, A.
Gonzalez, M.
Petersen, RH.
LTHT Author
Brunelli, Alessandro
Stefanou, Demetrios
Stefanou, Demetrios
LTHT Department
Thoracic Surgery
Non Medic
Publication Date
2025
Item Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Multicenter Study
Research Support, Non-U.S. Gov't
Language
Subject
Subject Headings
Abstract
OBJECTIVE: The study aimed to evaluate the risk of unforeseen nodal upstaging (pN+) after pulmonary segmentectomy without intraoperative frozen section.
METHODS: We conducted a retrospective analysis for consecutive patients who underwent segmentectomy for clinical stage IA1-2 non-small cell lung cancer (cIA1-2 NSCLC) in three centers between January 2017 and December 2022. A backward stepwise logistic regression analysis for variables with P < 0.1 in univariable analysis was performed to predict pN+. Kaplan-Meier analysis with log-rank test evaluated the discrepancy for overall (OS) and recurrence-free survivals (RFS).
RESULTS: Among 478 patients included in the final analysis, 19 (4.0%) had pN+, including 10 (2.1%) pN1, 6 (1.3%) pN2, and 3 (0.6%) pN1+2. With a median follow-up of 23.5 months (interquartile range 12.6-39.0), patients with pN+ had poorer OS compared to those with pN0 (3-year OS: 70.2% vs. 89.7%, P = 0.002). However, there was no significant difference in RFS and recurrence. The maximum standardized uptake value (SUVmax) of tumor in positron emission tomography scan >= 4.5 (versus < 4.5) was the only independent factor for pN + (odds ratio 3.5). Patients with a SUVmax >= 4.5 had 7.3% pN+, which was associated with poorer OS and similar RFS and recurrence compared to pN0. In contrast, those with a SUVmax < 4.5 had 2.2% pN+, which had comparable recurrence and survival to pN0.
CONCLUSION: Unforeseen nodal upstaging in segmentectomy for cIA1-2 NSCLC is low. Frozen section of lymph nodes may be necessary for lesions with high metabolic activity.
Journal
Surgical Endoscopy