A single-arm study of sublobar resection for ground-glass opacity dominant peripheral lung cancer

J Thorac Cardiovasc Surg. 2022 Jan;163(1):289-301.e2. doi: 10.1016/j.jtcvs.2020.09.146. Epub 2020 Nov 12.

Abstract

Background: The optimal mode of surgery for ground-glass opacity dominant peripheral lung cancer defined with thoracic thin-section computed tomography remains unknown.

Methods: We conducted a single-arm confirmatory trial to evaluate the efficacy and safety of sublobar resection for ground-glass opacity dominant peripheral lung cancer. Lung cancer with maximum tumor diameter 2.0 cm or less and with consolidation tumor ratio 0.25 or less based on thin-section computed tomography were registered. The primary end point was 5-year relapse-free survival. The planned sample size was 330 with the expected 5-year relapse-free survival of 98%, threshold of 95%, 1-sided α of 5%, and power of 90%. The trial is registered with University Hospital Medical Information Network Clinical Trials Registry, number University Hospital Medical Information Network 000002008.

Results: Between May 2009 and April 2011, 333 patients were enrolled from 51 institutions. Median age was 62 years (interquartile range, 56-68), and 109 were smokers. Median maximum tumor diameter was 1.20 cm (1.00-1.54). Median maximum tumor diameter of consolidation was 0 (0.00-0.20). The primary end point, 5-year relapse-free survival, was estimated on 314 patients who underwent sublobar resection. Operative modes were 258 wide wedge resections and 56 segmentectomies. Median pathological surgical margin was 15 mm (0-55). The 5-year relapse-free survival was 99.7% (90% confidence interval, 98.3-99.9), which met the primary end point. There was no local relapse. Grade 3 or higher postoperative complications based on Common Terminology Criteria for Adverse Effect v3.0 were observed in 17 patients (5.4%), without any grade 4 or 5.

Conclusions: Sublobar resection with enough surgical margin offered sufficient local control and relapse-free survival for lung cancer clinically resectable N0 staged by computed tomography with 3 or fewer peripheral lesions 2.0 cm or less amenable to sublobar resection and with a consolidation tumor ratio of 0.25 or less.

Keywords: GGO; lung cancer; prognosis; sublobar resection.

MeSH terms

  • Female
  • Humans
  • Japan / epidemiology
  • Lung Neoplasms* / epidemiology
  • Lung Neoplasms* / pathology
  • Lung Neoplasms* / surgery
  • Lung* / diagnostic imaging
  • Lung* / pathology
  • Male
  • Margins of Excision
  • Middle Aged
  • Multidetector Computed Tomography / methods
  • Neoplasm Staging
  • Pneumonectomy* / adverse effects
  • Pneumonectomy* / methods
  • Pneumonectomy* / statistics & numerical data
  • Postoperative Complications* / diagnosis
  • Postoperative Complications* / epidemiology
  • Prognosis
  • Progression-Free Survival
  • Treatment Outcome
  • Tumor Burden