Lung cancer (Amsterdam, Netherlands) · 2025
Threshold of adequate resection margin for sub-lobar resection in peripheral clinical stage IA1-2 non-small cell lung cancer with tumor spread through air spaces.
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Pan Hanbo, Yin Hui, Li Wanyu, Kong Weicheng, Zhang Jiaqi, Chen Hang, Ge Zhen, Tian Yu, Ning Junwei, Dai Zhizhuo, Huang Weiyang, Fang Liang, Zheng Min, Ruan Guomo, Chen Zhongjie, Zhang Ming, Niu Xiaomin, Huang Jia, Zhou Chengwei, Xu Guodong, Luo Qingquan
Аннотация
OBJECTIVES: Sub-lobar resection (SR) is an established treatment for peripheral clinical stage IA1-2 (cIA1-2) non-small cell lung cancer (NSCLC). However, it may fail to achieve complete resection and is associated with worse survival than lobar resection (LR) in spread through air spaces (STAS)+ populations. This study aims to define the threshold of an adequate SR margin that may yield survival outcomes comparable to LR in peripheral cIA1-2 STAS+ NSCLC.
METHODS: Consecutive patients with peripheral cIA1-2 (consolidation-to-tumor ratio > 0.5) NSCLC who underwent surgery between 2010 and 2020 across seven high-volume institutions were retrospectively reviewed. Stabilized inverse probability of treatment weighting (IPTW) was applied to mitigate selection bias. The primary endpoint was overall survival (OS), and the secondary endpoint was recurrence-free survival (RFS).
RESULTS: A total of 6,027 STAS+ and 15,994 STAS- patients were included. IPTW analyses demonstrated that SR was associated with improved long-term outcomes in STAS- populations, whereas LR provided superior outcomes in STAS+ populations. Greater resection margin length and higher margin-to-tumor ratio (MTR) were independently associated with improved OS and RFS in STAS+ but not in STAS- patients undergoing SR. Among STAS+ patients undergoing SR, cut-point analysis identified threshold values of 2.5 cm for resection margin length and 1.7 for MTR, which were validated in an external multi-center cohort. These cutoff values remained effective in patients with pathological visceral pleural invasion, lymphovascular invasion, or nodal involvement, and in those undergoing either segmentectomy or wedge resection.
CONCLUSIONS: In peripheral cIA1-2 NSCLC, STAS status may modify the prognostic impact of both resection extent and margin. For STAS+ patients, an SR margin length of ≥2.5 cm or an MTR of ≥1.7 may be recommended to achieve oncologic outcomes comparable to LR.
METHODS: Consecutive patients with peripheral cIA1-2 (consolidation-to-tumor ratio > 0.5) NSCLC who underwent surgery between 2010 and 2020 across seven high-volume institutions were retrospectively reviewed. Stabilized inverse probability of treatment weighting (IPTW) was applied to mitigate selection bias. The primary endpoint was overall survival (OS), and the secondary endpoint was recurrence-free survival (RFS).
RESULTS: A total of 6,027 STAS+ and 15,994 STAS- patients were included. IPTW analyses demonstrated that SR was associated with improved long-term outcomes in STAS- populations, whereas LR provided superior outcomes in STAS+ populations. Greater resection margin length and higher margin-to-tumor ratio (MTR) were independently associated with improved OS and RFS in STAS+ but not in STAS- patients undergoing SR. Among STAS+ patients undergoing SR, cut-point analysis identified threshold values of 2.5 cm for resection margin length and 1.7 for MTR, which were validated in an external multi-center cohort. These cutoff values remained effective in patients with pathological visceral pleural invasion, lymphovascular invasion, or nodal involvement, and in those undergoing either segmentectomy or wedge resection.
CONCLUSIONS: In peripheral cIA1-2 NSCLC, STAS status may modify the prognostic impact of both resection extent and margin. For STAS+ patients, an SR margin length of ≥2.5 cm or an MTR of ≥1.7 may be recommended to achieve oncologic outcomes comparable to LR.