Kamigaichi Atsushi, Mimae Takahiro, Tsubokawa Norifumi, Miyata Yoshihiro, Adachi Hiroyuki, Shimada Yoshihisa, Ito Hiroyuki, Ikeda Norihiko, Okada Morihito
Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan.
Interdiscip Cardiovasc Thorac Surg. 2023 Jan 9;36(1). doi: 10.1093/icvts/ivac285.
This study aimed to determine the clinical characteristics for predicting low-grade cancer in radiologically solid predominant non-small-cell lung cancer (NSCLC) and compare the survival outcomes of wedge resection with those of anatomical resection for patients with and without these characteristics.
Consecutive patients with clinical stages IA1-IA2 NSCLC showing radiologically solid predominance ≤2 cm at 3 institutions were retrospectively evaluated. Low-grade cancer was defined as the absence of nodal involvement and blood vessel, lymphatic and pleural invasion. The predictive criteria for low-grade cancer were established by multivariable analysis. The prognosis of wedge resection was compared with that of anatomical resection for patients who met the criteria, using the propensity score-matched analysis.
Among 669 patients, multivariable analysis showed that ground-glass opacity (GGO) (P < 0.001) on thin-section computed tomography and an increased maximum standardized uptake value on 18-fluoro-2-deoxyglucose positron emission tomography/computed tomography (P < 0.001) were independent predictors of low-grade cancer. The predictive criteria were defined as GGO presence and maximum standardized uptake value ≤1.1 (specificity: 97.8%, sensitivity: 21.4%). In the propensity score-matched pairs (n = 189), overall survival (P = 0.41) and relapse-free survival (P = 0.18) were not significantly different between patients who underwent wedge resection and anatomical resection among those who fulfilled the criteria.
The radiologic criteria for GGO and a low maximum standardized uptake value could predict low-grade cancer, even in solid-dominant NSCLC sized ≤2 cm. Wedge resection could be an acceptable surgical option for patients with radiologically predicted indolent NSCLC showing a solid-dominant appearance.
本研究旨在确定在放射学上以实性成分为主的非小细胞肺癌（NSCLC）中预测低级别癌症的临床特征，并比较具有和不具有这些特征的患者行楔形切除术与解剖性切除术的生存结果。
对3家机构中临床分期为IA1-IA2期、放射学表现为实性成分占比≤2 cm的NSCLC连续患者进行回顾性评估。低级别癌症定义为无淋巴结受累以及无血管、淋巴管和胸膜侵犯。通过多变量分析确定低级别癌症的预测标准。对于符合标准的患者，采用倾向评分匹配分析比较楔形切除术与解剖性切除术的预后。
在669例患者中，多变量分析显示薄层计算机断层扫描上的磨玻璃影（GGO）（P < 0.001）以及18氟-2-脱氧葡萄糖正电子发射断层扫描/计算机断层扫描上最大标准化摄取值升高（P < 0.001）是低级别癌症的独立预测因素。预测标准定义为存在GGO且最大标准化摄取值≤1.1（特异性：97.8%，敏感性：21.4%）。在倾向评分匹配对（n = 189）中，符合标准的患者中行楔形切除术与解剖性切除术的患者总生存期（P = 0.41）和无复发生存期（P = 0.18）无显著差异。
即使在直径≤2 cm的实性为主型NSCLC中，GGO和低最大标准化摄取值的放射学标准也可预测低级别癌症。对于放射学预测为惰性的实性为主型外观的NSCLC患者，楔形切除术可能是一种可接受的手术选择。
