European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2025
Comparison between sub-lobar resection and lobar resection for clinical stage IA (tumor size ≤ 2 cm) lung invasive mucinous adenocarcinoma with tumor spread through air spaces: A multi-center real-world study.
СтатьяМногоцентровое исследованиеСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Pan Hanbo, Kong Weicheng, Yin Hui, Shen Yaofeng, Chen Hang, Ge Zhen, Li Wanyu, Zhang Jiaqi, Tian Yu, Ning Junwei, Fang Liang, Dai Zhizhuo, Zheng Min, Chen Zhongjie, Ruan Guomo, Li Ziming, Zhang Ming, Zhou Chengwei, Xu Guodong, Huang Jia, Hu Yingjie, Luo Qingquan
Аннотация
BACKGROUND: Tumor spread through air spaces (STAS) has emerged as a significant prognostic factor in clinical stage IA (cIA) invasive mucinous adenocarcinoma (IMA) of the lung. However, it remains unclear whether sub-lobar resection (SR) offers survival outcomes comparable to those of lobar resection (LR) in this cohort. This study aimed to assess the efficacy of SR in patients with STAS-positive cIA (tumor size ≤2 cm) IMA using large-scale, multi-center, real-world data.
METHODS: We retrospectively reviewed consecutive patients with peripheral cIA (≤2 cm) STAS-positive IMA who underwent SR or LR between 2012 and 2020 at seven high-volume institutions across five Chinese cities. The primary endpoint was overall survival (OS), and the secondary endpoint was recurrence-free survival (RFS). Propensity-score matching (PSM) was employed to mitigate selection bias.
RESULTS: Among 567 included patients, PSM yielded 179 patients undergoing SR and 388 patients undergoing LR. Over a median follow-up of 6.2 years, SR demonstrated comparable 5-year OS (78.7 % versus 81.6 %, hazard ratio (HR) = 0.976, 95 % confidence interval (CI) = 0.693-1.375, P = 0.890) and RFS (69.0 % versus 71.8 %, HR = 1.017, 95 %CI = 0.752-1.376, P = 0.914) to LR. Subgroup analysis revealed that SR improved 5-year OS in patients aged ≥70 years (73.1 % versus 67.2 %, HR = 0.636, 95 %CI = 0.404-0.969, P = 0.040). Additionally, SR yielded similar outcomes in patients with visceral pleural invasion and exhibited a statistically nonsignificant trend toward lower survival in those with pathological N1-2 disease. Furthermore, LR, segmentectomy, and wedge resection yielded comparable 5-year OS and RFS.
CONCLUSION: Among patients with cIA (≤2 cm) STAS-positive IMA, SR provides 5-year OS and RFS outcomes comparable to LR and may confer a survival advantage among patients aged ≥70 years. These findings support the efficacy of SR and suggest that it should not be considered an adverse prognostic factor in this patient cohort.
METHODS: We retrospectively reviewed consecutive patients with peripheral cIA (≤2 cm) STAS-positive IMA who underwent SR or LR between 2012 and 2020 at seven high-volume institutions across five Chinese cities. The primary endpoint was overall survival (OS), and the secondary endpoint was recurrence-free survival (RFS). Propensity-score matching (PSM) was employed to mitigate selection bias.
RESULTS: Among 567 included patients, PSM yielded 179 patients undergoing SR and 388 patients undergoing LR. Over a median follow-up of 6.2 years, SR demonstrated comparable 5-year OS (78.7 % versus 81.6 %, hazard ratio (HR) = 0.976, 95 % confidence interval (CI) = 0.693-1.375, P = 0.890) and RFS (69.0 % versus 71.8 %, HR = 1.017, 95 %CI = 0.752-1.376, P = 0.914) to LR. Subgroup analysis revealed that SR improved 5-year OS in patients aged ≥70 years (73.1 % versus 67.2 %, HR = 0.636, 95 %CI = 0.404-0.969, P = 0.040). Additionally, SR yielded similar outcomes in patients with visceral pleural invasion and exhibited a statistically nonsignificant trend toward lower survival in those with pathological N1-2 disease. Furthermore, LR, segmentectomy, and wedge resection yielded comparable 5-year OS and RFS.
CONCLUSION: Among patients with cIA (≤2 cm) STAS-positive IMA, SR provides 5-year OS and RFS outcomes comparable to LR and may confer a survival advantage among patients aged ≥70 years. These findings support the efficacy of SR and suggest that it should not be considered an adverse prognostic factor in this patient cohort.