The risk factors for recurrence of peripheral solid small-nodule lung cancer (diameter≤2 cm) and the impact of different surgery types on survival: A propensity-score matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHOU Jian , XIAO Congjia , PU Qiang , MEI Jiandong , MA Lin , LIN Feng , LIU Chengwu , GUO Chenglin , LIAO Hu , ZHU Yunke , ZHENG Quan , CHEN Lei , CHE Guowei , WANG Yun , LIN Yidan , KOU Yingli , YUAN Yong , HU Yang , WU Zhu ,  LIU Lunxu

Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

LIU Lunxu, Email: lunxu_liu@aliyun.com

Keywords：

Solid small-nodule; recurrence; risk factor; surgery; propensity-score matching study

DOI：

10.7507/1007-4848.20211041

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To identify the risk factors for postoperative recurrence of peripheral solid small-nodule lung cancer (PSSNLC) (T≤2 cm), and to explore the effects of surgery types on prognosis. Methods We extracted data from Western China Lung Cancer Database (WCLCD), a prospectively maintained database at the Department of Thoracic Surgery, West China Hospital, Sichuan University, and Surveillance, Epidemiology, and End Results (SEER) database for peripheral solid small-nodule lung cancer patients (T≤2 cm N0M0, stageⅠ) who underwent surgerybetween 2005 and 2016. We used univariable and multivariable logistic regression to analyze risk factors for recurrence of PSSNLC. We applied propensity-score matching to compare the long-term results of segmentectomy and lobectomy, as well as the survival of patients from WCLCD and SEER. We finally included 4 800 patients with PSSNLC (T≤2 cm N0M0) (WCLCD∶SEER=354∶4 446). We matched 103 segmentectomies and 350 lobectomies in T≤1 cm, and 280 segmentectomies and1 067 lobectomies in 1 cm<T≤2 cm at a ratio of 1∶4 according to the propensity scores. Results The results of multivariable logistic regression showed that older age (HR=1.04, 95%CI 1.03-1.05, P<0.001), male (HR=1.60, 95%CI 1.37-1.88, P<0.001), squamous carcinoma (HR=1.65, 95%CI 1.40-1.95, P<0.001), lymph node removed (HR=0.97, 95%CI 0.96-0.99, P<0.001) were risk factors for recurrence after surgery. We found that segmentectomy and lobectomy could reach similar survival in PSSNLC patient with either T≤1 cm or 1 cm<T≤2 cm. Analyses of 1 441 patients with PSSNLC after matching (WCLCD∶SEER=325∶1 116) indicated that the 5-year overall survival rate of the patients in WCLCD was better than that in SEER database ( 89.8% vs. 77.1%, P<0.001). Conclusion Older age, male, squamous carcinoma, and lymph node removed are the risk factors for recurrence of PSSNLC. Segmentectomy shows similar survival in PSSNLC patient with either T≤1 cm or 1 cm<T≤2 cm N0M0. The patients in the WCLCD shows better survival compared with of the patients in the SEER database.

Citation： ZHOU Jian, XIAO Congjia, PU Qiang, MEI Jiandong, MA Lin, LIN Feng, LIU Chengwu, GUO Chenglin, LIAO Hu, ZHU Yunke, ZHENG Quan, CHEN Lei, CHE Guowei, WANG Yun, LIN Yidan, KOU Yingli, YUAN Yong, HU Yang, WU Zhu, LIU Lunxu. The risk factors for recurrence of peripheral solid small-nodule lung cancer (diameter≤2 cm) and the impact of different surgery types on survival: A propensity-score matching study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(11): 1283-1291. doi: 10.7507/1007-4848.20211041 Copy

1.	Boiselle PM. Computed tomography screening for lung cancer. JAMA, 2013, 309(11): 1163-1170.
2.	Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 2011, 365(5): 395-409.
3.	MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: From the Fleischner Society 2017. Radiology, 2017, 284(1): 228-243.
4.	Yip R, Li K, Liu L, et al. Controversies on lung cancers manifesting as part-solid nodules. Eur Radiol, 2018, 28(2): 747-759.
5.	Ettinger DS, Wood DE, Aisner DL, et al. NCCN guidelines insights: Non-small cell lung cancer, Version 2. 2021. J Natl Compr Canc Netw, 2021, 19(3): 254-266.
6.	Tsubokawa N, Tsutani Y, Miyata Y, et al. Segmentectomy versus lobectomy for radiologically pure solid clinical T1a-bN0M0 lung cancer. World J Surg, 2018, 42(8): 2493-2501.
7.	Tsutani Y, Miyata Y, Nakayama H, et al. Segmentectomy for clinical stage ⅠA lung adenocarcinoma showing solid dominance on radiology. Eur J Cardiothorac Surg, 2014, 46(4): 637-642.
8.	Fu F, Zhang Y, Wen Z, et al. Distinct prognostic factors in patients with stageⅠnon-small cell lung cancer with radiologic part-solid or solid lesions. J Thorac Oncol, 2019, 14(12): 2133-2142.
9.	Hattori A, Matsunaga T, Takamochi K, et al. Locoregional recurrence after segmentectomy for clinical-T1aN0M0 radiologically solid non-small-cell lung carcinoma. Eur J Cardiothorac Surg, 2017, 51(3): 518-525.
10.	Nomori H, Shiraishi A, Cong Y, et al. Differences in postoperative changes in pulmonary functions following segmentectomy compared with lobectomy. Eur J Cardiothorac Surg, 2018, 53(3): 640-647.
11.	Tane S, Nishio W, Nishioka Y, et al. Evaluation of the residual lung function after thoracoscopic segmentectomy compared with lobectomy. Ann Thorac Surg, 2019, 108(5): 1543-1550.
12.	Koike T, Kitahara A, Sato S, et al. Lobectomy versus segmentectomy in radiologically pure solid small-sized non-small cell lung cancer. Ann Thorac Surg, 2016, 101(4): 1354-1360.
13.	Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med, 2009, 28(25): 3083-3107.
14.	Agarwal M, Brahmanday G, Chmielewski GW, et al. Age, tumor size, type of surgery, and gender predict survival in early stage (stageⅠand Ⅱ) non-small cell lung cancer after surgical resection. Lung Cancer, 2010, 68(3): 398-402.
15.	Tas F, Ciftci R, Kilic L, et al. Age is a prognostic factor affecting survival in lung cancer patients. Oncol Lett, 2013, 6(5): 1507-1513.
16.	Sakurai H, Asamura H, Goya T, et al. Survival differences by gender for resected non-small cell lung cancer: A retrospective analysis of 12, 509 cases in a Japanese Lung Cancer Registry study. J Thorac Oncol, 2010, 5(10): 1594-1601.
17.	Wang C, Wu Y, Shao J, et al. Clinicopathological variables influencing overall survival, recurrence and post-recurrence survival in resected stageⅠnon-small-cell lung cancer. BMC Cancer, 2020, 20(1): 150.
18.	Wang T, Deng J, She Y, et al. Radiomics signature predicts the recurrence-free survival in stageⅠnon-small cell lung cancer. Ann Thorac Surg, 2020, 109(6): 1741-1749.
19.	Nakamura K, Saji H, Nakajima R, et al. A phase Ⅲ randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). Jpn J Clin Oncol, 2010, 40(3): 271-274.
20.	刘伦旭, 车国卫, 蒲强, 等. 单向式全胸腔镜肺叶切除术. 中华胸心血管外科杂志, 2008, 24(3): 156-158.
21.	Liu L, Che G, Pu Q, et al. A new concept of endoscopic lung cancer resection: Single-direction thoracoscopic lobectomy. Surg Oncol, 2010, 19(2): e71-e77.
22.	Mei J, Guo C, Xia L, et al. Long-term survival outcomes of video-assisted thoracic surgery lobectomy for stageⅠ-Ⅱ non-small cell lung cancer are more favorable than thoracotomy: A propensity score-matched analysis from a high-volume center in China. Transl Lung Cancer Res, 2019, 8(2): 155-166.
23.	Liu C, Liao H, Guo C, et al. Single-direction thoracoscopic basal segmentectomy. J Thorac Cardiovasc Surg, 2020, 160(6): 1586-1594.
24.	Zhu Y, Pu Q, Liu C, et al. Trans-inferior-pulmonary-ligament single-direction thoracoscopic RS9 segmentectomy: Application of stem-branch method for tracking anatomy. Ann Surg Oncol, 2020, 27(8): 3092-3093.
25.	周健, 蒲强, 梅建东, 等. 单孔与三孔胸腔镜肺叶切除术治疗肺癌2112例围术期效果的比较: 一项倾向性评分匹配研究. 中国胸心血管外科临床杂志, 2021, 28(9): 1005-1011.
26.	Wei S, Guo C, He J, et al. Effect of vein-first vs. artery-first surgical technique on circulating tumor cells and survival in patients with non-small cell lung cancer: A randomized clinical trial and registry-based propensity score matching analysis. JAMA Surg, 2019, 154(7): e190972.
27.	Liu C, Pu Q, Guo C, et al. Non-grasping en bloc mediastinal lymph node dissection for video-assisted thoracoscopic lung cancer surgery. BMC Surg, 2015, 15: 38.
28.	Liu C, Ma L, Guo C, et al. Non-grasping en bloc mediastinal lymph node dissection through uniportal video-assisted thoracic surgery for lung cancer surgery. J Thorac Dis, 2016, 8(10): 2956-2959.

1. Boiselle PM. Computed tomography screening for lung cancer. JAMA, 2013, 309(11): 1163-1170.
2. Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med, 2011, 365(5): 395-409.
3. MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: From the Fleischner Society 2017. Radiology, 2017, 284(1): 228-243.
4. Yip R, Li K, Liu L, et al. Controversies on lung cancers manifesting as part-solid nodules. Eur Radiol, 2018, 28(2): 747-759.
5. Ettinger DS, Wood DE, Aisner DL, et al. NCCN guidelines insights: Non-small cell lung cancer, Version 2. 2021. J Natl Compr Canc Netw, 2021, 19(3): 254-266.
6. Tsubokawa N, Tsutani Y, Miyata Y, et al. Segmentectomy versus lobectomy for radiologically pure solid clinical T1a-bN0M0 lung cancer. World J Surg, 2018, 42(8): 2493-2501.
7. Tsutani Y, Miyata Y, Nakayama H, et al. Segmentectomy for clinical stage ⅠA lung adenocarcinoma showing solid dominance on radiology. Eur J Cardiothorac Surg, 2014, 46(4): 637-642.
8. Fu F, Zhang Y, Wen Z, et al. Distinct prognostic factors in patients with stageⅠnon-small cell lung cancer with radiologic part-solid or solid lesions. J Thorac Oncol, 2019, 14(12): 2133-2142.
9. Hattori A, Matsunaga T, Takamochi K, et al. Locoregional recurrence after segmentectomy for clinical-T1aN0M0 radiologically solid non-small-cell lung carcinoma. Eur J Cardiothorac Surg, 2017, 51(3): 518-525.
10. Nomori H, Shiraishi A, Cong Y, et al. Differences in postoperative changes in pulmonary functions following segmentectomy compared with lobectomy. Eur J Cardiothorac Surg, 2018, 53(3): 640-647.
11. Tane S, Nishio W, Nishioka Y, et al. Evaluation of the residual lung function after thoracoscopic segmentectomy compared with lobectomy. Ann Thorac Surg, 2019, 108(5): 1543-1550.
12. Koike T, Kitahara A, Sato S, et al. Lobectomy versus segmentectomy in radiologically pure solid small-sized non-small cell lung cancer. Ann Thorac Surg, 2016, 101(4): 1354-1360.
13. Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med, 2009, 28(25): 3083-3107.
14. Agarwal M, Brahmanday G, Chmielewski GW, et al. Age, tumor size, type of surgery, and gender predict survival in early stage (stageⅠand Ⅱ) non-small cell lung cancer after surgical resection. Lung Cancer, 2010, 68(3): 398-402.
15. Tas F, Ciftci R, Kilic L, et al. Age is a prognostic factor affecting survival in lung cancer patients. Oncol Lett, 2013, 6(5): 1507-1513.
16. Sakurai H, Asamura H, Goya T, et al. Survival differences by gender for resected non-small cell lung cancer: A retrospective analysis of 12, 509 cases in a Japanese Lung Cancer Registry study. J Thorac Oncol, 2010, 5(10): 1594-1601.
17. Wang C, Wu Y, Shao J, et al. Clinicopathological variables influencing overall survival, recurrence and post-recurrence survival in resected stageⅠnon-small-cell lung cancer. BMC Cancer, 2020, 20(1): 150.
18. Wang T, Deng J, She Y, et al. Radiomics signature predicts the recurrence-free survival in stageⅠnon-small cell lung cancer. Ann Thorac Surg, 2020, 109(6): 1741-1749.
19. Nakamura K, Saji H, Nakajima R, et al. A phase Ⅲ randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). Jpn J Clin Oncol, 2010, 40(3): 271-274.
20. 刘伦旭, 车国卫, 蒲强, 等. 单向式全胸腔镜肺叶切除术. 中华胸心血管外科杂志, 2008, 24(3): 156-158.
21. Liu L, Che G, Pu Q, et al. A new concept of endoscopic lung cancer resection: Single-direction thoracoscopic lobectomy. Surg Oncol, 2010, 19(2): e71-e77.
22. Mei J, Guo C, Xia L, et al. Long-term survival outcomes of video-assisted thoracic surgery lobectomy for stageⅠ-Ⅱ non-small cell lung cancer are more favorable than thoracotomy: A propensity score-matched analysis from a high-volume center in China. Transl Lung Cancer Res, 2019, 8(2): 155-166.
23. Liu C, Liao H, Guo C, et al. Single-direction thoracoscopic basal segmentectomy. J Thorac Cardiovasc Surg, 2020, 160(6): 1586-1594.
24. Zhu Y, Pu Q, Liu C, et al. Trans-inferior-pulmonary-ligament single-direction thoracoscopic RS9 segmentectomy: Application of stem-branch method for tracking anatomy. Ann Surg Oncol, 2020, 27(8): 3092-3093.
25. 周健, 蒲强, 梅建东, 等. 单孔与三孔胸腔镜肺叶切除术治疗肺癌2112例围术期效果的比较: 一项倾向性评分匹配研究. 中国胸心血管外科临床杂志, 2021, 28(9): 1005-1011.
26. Wei S, Guo C, He J, et al. Effect of vein-first vs. artery-first surgical technique on circulating tumor cells and survival in patients with non-small cell lung cancer: A randomized clinical trial and registry-based propensity score matching analysis. JAMA Surg, 2019, 154(7): e190972.
27. Liu C, Pu Q, Guo C, et al. Non-grasping en bloc mediastinal lymph node dissection for video-assisted thoracoscopic lung cancer surgery. BMC Surg, 2015, 15: 38.
28. Liu C, Ma L, Guo C, et al. Non-grasping en bloc mediastinal lymph node dissection through uniportal video-assisted thoracic surgery for lung cancer surgery. J Thorac Dis, 2016, 8(10): 2956-2959.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The risk factors for recurrence of peripheral solid small-nodule lung cancer (diameter≤2 cm) and the impact of different surgery types on survival: A propensity-score matching study

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content