Outcomes of Patients Undergoing Segmentectomy for Occult Node-Positive Clinical Stage IA Lung Cancer.

Background: Results of recent clinical trials suggest that segmentectomy may be an acceptable alternative to lobectomy for selected patients with early-stage non-small cell lung cancer (NSCLC). Increased use of segmentectomy may result in a concomitant increase in occult node-positive (N+) disease on surgical pathology examination. The optimal management for such patients remains unknown.
Methods: Clinicopathologic data were abstracted from a prospective institutional database to identify patients with pathologic N+ disease after segmentectomy for cT1 N0 M0 NSCLC. Propensity score matching identified a comparable lobectomy cohort for assessment of cumulative incidence of recurrence and overall survival (OS).
Results: Of 759 included patients, 27 (4%) had nodal upstaging on the final pathology report. Of these 27 patients, 4 (15%) had skip metastasis to N2 stations, and 20 (74%) received adjuvant therapy; no completion lobectomies were performed. Ten patients (37%) had disease recurrence: 3 isolated locoregional (11%) and 7 distant (26%). The median time to recurrence among patients with recurrence was 1.8 years; OS after recurrence was 3.4 years. After 5:1 matching with 109 patients who underwent lobectomy, all variables were balanced between the groups, except pathologic N2 stage and open surgical approach. The 5-year cumulative incidence of recurrence was not significantly different between segmentectomy and lobectomy (42% vs 52%, respectively; Gray's P = .1). The 5-year OS (63% and 50%) and rate of locoregional recurrence (12% vs 13%) were not statistically different between the groups.
Conclusions: Patients with occult N+ disease after segmentectomy for cT1 N0 M0 NSCLC had limited isolated locoregional recurrences and outcomes similar to those in patients who underwent lobectomy. Lobectomy may not provide an advantage in these patients.
Competing Interests: Disclosures James M. Isbell has served as an advisory board member for AstraZeneca and Merck; has served as an uncompensated steering board member for Genentech; has received travel support from Intuitive Surgical; and has equity or ownership interest in LumaCyte. Daniela Molena has served on a steering committee for AstraZeneca; has served as a consultant for Johnson & Johnson, Bristol Myers Squibb, AstraZeneca, and Boston Scientific; and has been an invited speaker for Merck and Genentech. Bernard J. Park has received honoraria from Intuitive Surgical, AstraZeneca, and Medtronic; and has served as a consultant for Ceevra. Gaetano Rocco has a financial relationship with Scanlan, Merck, and Medtronic. Valerie W. Rusch has received other support from DaVinci Surgery; has received nonfinancial support from Bristol Myers Squibb; and has received personal fees from the NIH Coordinating Center for Clinical Trials. Smita Sihag has served as a member of the AstraZeneca advisory board. David R. Jones has served as a member of the advisory council for AstraZeneca and the Advisory Committee for More Health; and has been a speaker for DAVA Oncology. Matthew J. Bott has served as a consultant for AstraZeneca Pharmaceuticals, Iovance Biotherapeutics, and Intuitive Surgical.
(Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)