Postoperative adjuvant treatment for elderly or patients with low cardiopulmonary function with stageⅠA non-small cell lung cancer of peripheral solid pathology after compromised sublobar resection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LU Yu ¹ , ZHANG Jialin ¹ , NIU Haoyan ¹ , KE Honggang ² , WENG Xiaodan ² , ZHAO Jiaping ³ ,  ZHOU Hao ²

1. Medical College of Nantong University, Nantong, 226001, Jiangsu, P. R. China;
2. Department of Thoracic Surgery, Affiliated Hospital of Nantong University, Nantong, 226001, Jiangsu, P. R. China;
3. Department of Thoracic Surgery, Shanghai Fifth People's Hospital, Shanghai, 200240, P. R. China;

Corresponding author：

ZHOU Hao, Email: 15896267262@163.com

Keywords：

Non-small cell lung cancer; adjuvant therapy; sublobar resection; chemotherapy; targeted therapy

DOI：

10.7507/1007-4848.202409017

Video：

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Objective To explore the adjuvant treatment options for elderly patients or those with low cardiopulmonary function who cannot tolerate lobectomy for peripheral solid pathological stage ⅠA (pⅠA) non-small cell lung cancer (NSCLC). Methods A retrospective analysis was conducted on the clinical data of patients with peripheral solid pⅠA stage NSCLC treated with lobectomy and compromised sublobar resection (CSR) in our center from 2018 to 2019. The incidence of postoperative complications and independent predictors of postoperative recurrence were analyzed. Patients in the CSR group were divided into a targeted therapy group, a chemotherapy group, and an observation group based on postoperative treatment measures. The 3-year recurrence-free survival (RFS) rate and 5-year overall survival (OS) rate of the three subgroups before and after propensity score matching (PSM) were compared. Results A total of 586 patients were included, including 288 males (49.15%) and 298 females (50.85%), with a median age of 64.00 years. There were 335 patients of lobectomy and 251 patients of compromised sublobar resection. There was no statistically significant difference in the incidence of postoperative complications between the lobectomy group and CSR group [RR=0.987, 95%CI (0.898, 1.085), P=0.789). Multivariate analysis showed that gender, tumor location, and size were independent risk factors for recurrence after CSR. After PSM, 17 patients were enrolled in each of the three subgroups of CSR. Kaplan-Meier survival curve analysis showed that there was no statistically significant difference in the 3-year RFS rate (P=0.115) and 5-year OS rate (P=0.101) between the targeted therapy group and the chemotherapy group after PSM, but both were significantly better than those in the observation group (P=0.041, P=0.009). Compared with lobectomy, there was no statistically significant difference in the 3-year RFS rate (P=0.069) and 5-year OS rate (P=0.540) in the targeted therapy group, while the chemotherapy group and observation group were significantly inferior to the lobectomy group (P<0.05). Conclusion CSR for treating elderly patients or those with low cardiopulmonary function with peripheral solid pⅠA stage NSCLC does not increase the incidence of postoperative complications. Gender, tumor location, and size are independent risk factors for postoperative recurrence. In terms of 3-year RFS rate and 5-year OS rate, adjuvant targeted therapy after CSR is not only superior to chemotherapy or observation but is also not inferior to lobectomy.

1.	Miller KD, Nogueira L, Devasia T, et al. Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin, 2022, 72(5): 409-436.
2.	Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-622.
3.	Moon Y, Sung SW, Moon SW, et al. Risk factors for recurrence after sublobar resection in patients with small (2 cm or less) non-small cell lung cancer presenting as a solid-predominant tumor on chest computed tomography. J Thorac Dis, 2016, 8(8): 2018-2026.
4.	Hattori A, Suzuki K, Takamochi K, et al. Prognostic impact of a ground-glass opacity component in clinical stageⅠA non-small cell lung cancer. J Thorac Cardiovasc Surg, 2021, 161(4): 1469-1480.
5.	Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
6.	Aokage K, Suzuki K, Saji H, et al. Segmentectomy for ground-glass-dominant lung cancer with a tumour diameter of 3 cm or less including ground-glass opacity (JCOG1211): A multicentre, single-arm, confirmatory, phase 3 trial. Lancet Respir Med, 2023, 11(6): 540-549.
7.	Nagata Y, Wulf J, Lax I, et al. Stereotactic radiotherapy of primary lung cancer and other targets: Results of consultant meeting of the International Atomic Energy Agency. Int J Radiat Oncol Biol Phys, 2011, 79(3): 660-669.
8.	Dupuy DE, Fernando HC, Hillman S, et al. Radiofrequency ablation of stage ⅠA non-small cell lung cancer in medically inoperable patients: Results from the American College of Surgeons Oncology Group Z4033 (Alliance) trial. Cancer, 2015, 121(19): 3491-3498.
9.	Ettinger DS, Wood DE, Aggarwal C, et al. NCCN guidelines insights: Non-small cell lung cancer, version 1. 2020. J Natl Compr Canc Netw, 2019, 17(12): 1464-1472.
10.	Moreira AL, Ocampo PSS, Xia Y, et al. A grading system for invasive pulmonary adenocarcinoma: A proposal from the International Association for the Study of Lung Cancer Pathology Committee. J Thorac Oncol, 2020, 15(10): 1599-1610.
11.	Pennathur A, Brunelli A, Criner GJ, et al. Definition and assessment of high risk in patients considered for lobectomy for stageⅠnon-small cell lung cancer: The American Association for Thoracic Surgery expert panel consensus document. J Thorac Cardiovasc Surg, 2021, 162(6): 1605-1618.
12.	Altorki NK, Wang X, Wigle D, et al. Perioperative mortality and morbidity after sublobar versus lobar resection for early-stage non-small-cell lung cancer: Post-hoc analysis of an international, randomised, phase 3 trial (CALGB/Alliance 140503). Lancet Respir Med, 2018, 6(12): 915-924.
13.	Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
14.	Lin H, Peng Z, Zhou K, et al. Differential efficacy of segmentectomy and wedge resection in sublobar resection compared to lobectomy for solid-dominant stage ⅠA lung cancer: A systematic review and meta-analysis. Int J Surg, 2024, 110(2): 1159-1171.
15.	Ito H, Suzuki K, Mizutani T, et al. Long-term survival outcome after lobectomy in patients with clinical T1 N0 lung cancer. J Thorac Cardiovasc Surg, 2020, 11: S0022-5223.
16.	Hattori A, Hirayama S, Matsunaga T, et al. Distinct clinicopathologic characteristics and prognosis based on the presence of ground glass opacity component in clinical stage ⅠA lung adenocarcinoma. J Thorac Oncol, 2019, 14(2): 265-275.
17.	Watanabe K, Sakamaki K, Nishii T, et al. Gender differences in the recurrence timing of patients undergoing resection for non-small cell lung cancer. Asian Pac J Cancer Prev, 2018, 19(3): 719-724.
18.	Varlotto JM, Medford-Davis LN, Recht A, et al. Identification of stageⅠnon-small cell lung cancer patients at high risk for local recurrence following sublobar resection. Chest, 2013, 143(5): 1365-1377.
19.	Kuo WK, Chen PJ, Wu MH, et al. Tumor location is an independent prognostic factor in completely resected pathological stageⅠnon-small cell lung cancer: A multicenter retrospective study. Cancers (Basel), 2024, 16(9): 1710.
20.	Pignon JP, Tribodet H, Scagliotti GV, et al. Lung adjuvant cisplatin evaluation: A pooled analysis by the LACE Collaborative Group. J Clin Oncol, 2008, 26(21): 3552-3559.
21.	Passaro A, Mok TSK, Attili I, et al. Adjuvant treatments for surgically resected non-small cell lung cancer harboring EGFR mutations: A review. JAMA Oncol, 2023, 9(8): 1124-1131.
22.	Herbst RS, Wu YL, John T, et al. Adjuvant Osimertinib for resected EGFR-mutated stage ⅠB-ⅢA non-small-cell lung cancer: Updated results from the phase Ⅲrandomized ADAURA trial. J Clin Oncol, 2023, 41(10): 1830-1840.
23.	Jiang Y, Lin Y, Fu W, et al. The impact of adjuvant EGFR-TKIs and 14-gene molecular assay on stageⅠnon-small cell lung cancer with sensitive EGFR mutations. EClinicalMedicine, 2023, 64: 102205.
24.	Zhao M, Lu T, Huang Y, et al. Survival and long-term cause-specific mortality associated with stageⅠa lung adenocarcinoma after wedge resection vs. segmentectomy: A population-based propensity score matching and competing risk analysis. Front Oncol, 2019, 9: 593.
25.	Zhang H, Liu C, Tan Z, et al. Segmentectomy versus wedge resection for stage Ⅰnon-small cell lung cancer: A meta-analysis. J Surg Res, 2019, 243: 371-379.
26.	Hou B, Deng XF, Zhou D, et al. Segmentectomy versus wedge resection for the treatment of high-risk operable patients with stageⅠnon-small cell lung cancer: A meta-analysis. Ther Adv Respir Dis, 2016, 10(5): 435-443.Hou B, Deng XF, Zhou D, et al. Segmentectomy versus wedge resection for the treatment of high-risk operable patients with stageⅠnon-small cell lung cancer: A meta-analysis. Ther Adv Respir Dis, 2016, 10(5): 435-443.

1. Miller KD, Nogueira L, Devasia T, et al. Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin, 2022, 72(5): 409-436.
2. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-622.
3. Moon Y, Sung SW, Moon SW, et al. Risk factors for recurrence after sublobar resection in patients with small (2 cm or less) non-small cell lung cancer presenting as a solid-predominant tumor on chest computed tomography. J Thorac Dis, 2016, 8(8): 2018-2026.
4. Hattori A, Suzuki K, Takamochi K, et al. Prognostic impact of a ground-glass opacity component in clinical stageⅠA non-small cell lung cancer. J Thorac Cardiovasc Surg, 2021, 161(4): 1469-1480.
5. Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
6. Aokage K, Suzuki K, Saji H, et al. Segmentectomy for ground-glass-dominant lung cancer with a tumour diameter of 3 cm or less including ground-glass opacity (JCOG1211): A multicentre, single-arm, confirmatory, phase 3 trial. Lancet Respir Med, 2023, 11(6): 540-549.
7. Nagata Y, Wulf J, Lax I, et al. Stereotactic radiotherapy of primary lung cancer and other targets: Results of consultant meeting of the International Atomic Energy Agency. Int J Radiat Oncol Biol Phys, 2011, 79(3): 660-669.
8. Dupuy DE, Fernando HC, Hillman S, et al. Radiofrequency ablation of stage ⅠA non-small cell lung cancer in medically inoperable patients: Results from the American College of Surgeons Oncology Group Z4033 (Alliance) trial. Cancer, 2015, 121(19): 3491-3498.
9. Ettinger DS, Wood DE, Aggarwal C, et al. NCCN guidelines insights: Non-small cell lung cancer, version 1. 2020. J Natl Compr Canc Netw, 2019, 17(12): 1464-1472.
10. Moreira AL, Ocampo PSS, Xia Y, et al. A grading system for invasive pulmonary adenocarcinoma: A proposal from the International Association for the Study of Lung Cancer Pathology Committee. J Thorac Oncol, 2020, 15(10): 1599-1610.
11. Pennathur A, Brunelli A, Criner GJ, et al. Definition and assessment of high risk in patients considered for lobectomy for stageⅠnon-small cell lung cancer: The American Association for Thoracic Surgery expert panel consensus document. J Thorac Cardiovasc Surg, 2021, 162(6): 1605-1618.
12. Altorki NK, Wang X, Wigle D, et al. Perioperative mortality and morbidity after sublobar versus lobar resection for early-stage non-small-cell lung cancer: Post-hoc analysis of an international, randomised, phase 3 trial (CALGB/Alliance 140503). Lancet Respir Med, 2018, 6(12): 915-924.
13. Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
14. Lin H, Peng Z, Zhou K, et al. Differential efficacy of segmentectomy and wedge resection in sublobar resection compared to lobectomy for solid-dominant stage ⅠA lung cancer: A systematic review and meta-analysis. Int J Surg, 2024, 110(2): 1159-1171.
15. Ito H, Suzuki K, Mizutani T, et al. Long-term survival outcome after lobectomy in patients with clinical T1 N0 lung cancer. J Thorac Cardiovasc Surg, 2020, 11: S0022-5223.
16. Hattori A, Hirayama S, Matsunaga T, et al. Distinct clinicopathologic characteristics and prognosis based on the presence of ground glass opacity component in clinical stage ⅠA lung adenocarcinoma. J Thorac Oncol, 2019, 14(2): 265-275.
17. Watanabe K, Sakamaki K, Nishii T, et al. Gender differences in the recurrence timing of patients undergoing resection for non-small cell lung cancer. Asian Pac J Cancer Prev, 2018, 19(3): 719-724.
18. Varlotto JM, Medford-Davis LN, Recht A, et al. Identification of stageⅠnon-small cell lung cancer patients at high risk for local recurrence following sublobar resection. Chest, 2013, 143(5): 1365-1377.
19. Kuo WK, Chen PJ, Wu MH, et al. Tumor location is an independent prognostic factor in completely resected pathological stageⅠnon-small cell lung cancer: A multicenter retrospective study. Cancers (Basel), 2024, 16(9): 1710.
20. Pignon JP, Tribodet H, Scagliotti GV, et al. Lung adjuvant cisplatin evaluation: A pooled analysis by the LACE Collaborative Group. J Clin Oncol, 2008, 26(21): 3552-3559.
21. Passaro A, Mok TSK, Attili I, et al. Adjuvant treatments for surgically resected non-small cell lung cancer harboring EGFR mutations: A review. JAMA Oncol, 2023, 9(8): 1124-1131.
22. Herbst RS, Wu YL, John T, et al. Adjuvant Osimertinib for resected EGFR-mutated stage ⅠB-ⅢA non-small-cell lung cancer: Updated results from the phase Ⅲrandomized ADAURA trial. J Clin Oncol, 2023, 41(10): 1830-1840.
23. Jiang Y, Lin Y, Fu W, et al. The impact of adjuvant EGFR-TKIs and 14-gene molecular assay on stageⅠnon-small cell lung cancer with sensitive EGFR mutations. EClinicalMedicine, 2023, 64: 102205.
24. Zhao M, Lu T, Huang Y, et al. Survival and long-term cause-specific mortality associated with stageⅠa lung adenocarcinoma after wedge resection vs. segmentectomy: A population-based propensity score matching and competing risk analysis. Front Oncol, 2019, 9: 593.
25. Zhang H, Liu C, Tan Z, et al. Segmentectomy versus wedge resection for stage Ⅰnon-small cell lung cancer: A meta-analysis. J Surg Res, 2019, 243: 371-379.
26. Hou B, Deng XF, Zhou D, et al. Segmentectomy versus wedge resection for the treatment of high-risk operable patients with stageⅠnon-small cell lung cancer: A meta-analysis. Ther Adv Respir Dis, 2016, 10(5): 435-443.Hou B, Deng XF, Zhou D, et al. Segmentectomy versus wedge resection for the treatment of high-risk operable patients with stageⅠnon-small cell lung cancer: A meta-analysis. Ther Adv Respir Dis, 2016, 10(5): 435-443.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesPostoperative adjuvant treatment for elderly or patients with low cardiopulmonary function with stageⅠA non-small cell lung cancer of peripheral solid pathology after compromised sublobar resection

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