Optimal sublobar resection for c-stage I non-small cell lung cancer: significance of margin distance to tumor size ratio and margin cytology (Supplementary analysis of KLSG-0801): complete republication

Abstract

Background

Sublobar resection for lung cancer is associated with a higher risk of recurrence than that of lobectomy; we evaluated the factors considered to be predictors of recurrence.

Methods

By analyzing multicenter prospective studies of sublobar resection for patients with c-stage I non-small lung cancer who were unable to undergo lobectomy (KLSG-0801), we investigated the relationship between (1) tumor location (TL) and margin distance from the stump (MD), (2) the MD/tumor size (TS) ratio and prognosis, (3) and the margin cytology (MC) and prognosis.

Results

The correlation between TS and MD was statistically significant in cases of easily resectable regions defined by Lewis' classification (n = 18). However, there was no correlation in difficult-to-resect regions (n = 14). Among cases of recurrence, the MD/TS ratio was less than 1. The 3-year survival rate was 100% for patients with MD/TS > 1 (n = 12), 59.7% for patients with MD/TS ≤ 1 (n = 20) (p = 0.06), 88.1% in cases of negative MC (n = 18), and 20% in cases of positive MC (n = 5) (p = 0.001).

Conclusion

Cases with positive MC had a significantly worse prognosis than those with negative MC. It may be difficult to secure an MD greater than the TS in a difficult-to-resect region according to Lewis' classification.

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