Impact of margin distance and lymphadenectomy on recurrence after wedge resection versus segmentectomy for clinical stage IA non-small cell lung cancer
Presented During:
Sunday, May 4, 2025: 9:00AM - 4:00PM
Seattle Convention Center | Summit
Posted Room Name:
Poster Area, Exhibit Hall
Abstract No:
P0174
Submission Type:
Abstract Submission
Authors:
Lin Huang (1), Rene Petersen (1)
Institutions:
(1) Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
Submitting Author:
Lin Huang
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Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet
Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet
Co-Author:
*Rene Petersen
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Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet
Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet
Presenting Author:
Lin Huang
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Rigshospitalet
Rigshospitalet
Abstract:
Objectives: This study aims to evaluate the influence of margin distance and lymphadenectomy on recurrence after wedge resection versus segmentectomy for clinical stage IA non-small cell lung cancer (cIA NSCLC).
Methods: We retrospectively reviewed prospectively collected data of patients who underwent thoracoscopic sublobar resection for cIA NSCLC from November 2016 to December 2023. Recurrence was analyzed using a time-to-event approach. Multivariable Cox regression analysis was performed to identify associations with recurrence-free survival (RFS). Propensity score matching (PSM) was applied to minimize bias in preoperative characteristics between the wedge resection and segmentectomy groups. The Kaplan-Meier method with the log-rank test and the Aalen-Johansen estimator with Gray's test were used to assess differences in RFS in the overall cohort and subgroups.
Results: A total of 334 patients were included, with 201 undergoing wedge resection and 133 undergoing segmentectomy. Multivariable analysis identified segmentectomy (hazard ratio [HR] 0.47, p = 0.003), margin distance ≥ 2.0 cm (HR 0.51, p = 0.016), ≥ 10 total lymph nodes (HR 0.33, p = 0.001), ≥ 1 N1 station (HR 0.49, 0.002), and ≥ 3 N2 stations (HR 0.67, p = 0.038) as predictive factors for improved RFS after sublobar resection. Margin-to-tumor ratio ≥ 1 was not a significant factor. The wedge resection group was less likely to achieve appropriate margin distance and lymph nodes dissection compared to the segmentectomy group both before and after PSM with p < 0.001. With a mean follow-up period of three years, the wedge resection group had poorer 5-year RFS compared to the segmentectomy group before PSM (45.8% vs. 76.6%, p <0.001) and after PSM (51.8% vs. 75.7%, p = 0.012). However, RFS was nearly similar between the two groups when margin distances were ≥ 2.0 cm, ≥ 10 total lymph nodes, or ≥ 3 N2 stations before PSM. After PSM, RFS remained comparable for margin distances ≥ 2.0 cm and ≥ 1 N1 stations. (Table 1) No significant difference was found in specific recurrence or cause of death between the two groups across all subgroups.
Conclusion: Segmentectomy offers superior survival compared to wedge resection for clinical stage IA NSCLC, with better resection margins, more extensive lymph node removal, and a lower recurrence rate. However, when margin distance and lymphadenectomy are optimized, wedge resection may achieve a comparable prognosis.
Methods: We retrospectively reviewed prospectively collected data of patients who underwent thoracoscopic sublobar resection for cIA NSCLC from November 2016 to December 2023. Recurrence was analyzed using a time-to-event approach. Multivariable Cox regression analysis was performed to identify associations with recurrence-free survival (RFS). Propensity score matching (PSM) was applied to minimize bias in preoperative characteristics between the wedge resection and segmentectomy groups. The Kaplan-Meier method with the log-rank test and the Aalen-Johansen estimator with Gray's test were used to assess differences in RFS in the overall cohort and subgroups.
Results: A total of 334 patients were included, with 201 undergoing wedge resection and 133 undergoing segmentectomy. Multivariable analysis identified segmentectomy (hazard ratio [HR] 0.47, p = 0.003), margin distance ≥ 2.0 cm (HR 0.51, p = 0.016), ≥ 10 total lymph nodes (HR 0.33, p = 0.001), ≥ 1 N1 station (HR 0.49, 0.002), and ≥ 3 N2 stations (HR 0.67, p = 0.038) as predictive factors for improved RFS after sublobar resection. Margin-to-tumor ratio ≥ 1 was not a significant factor. The wedge resection group was less likely to achieve appropriate margin distance and lymph nodes dissection compared to the segmentectomy group both before and after PSM with p < 0.001. With a mean follow-up period of three years, the wedge resection group had poorer 5-year RFS compared to the segmentectomy group before PSM (45.8% vs. 76.6%, p <0.001) and after PSM (51.8% vs. 75.7%, p = 0.012). However, RFS was nearly similar between the two groups when margin distances were ≥ 2.0 cm, ≥ 10 total lymph nodes, or ≥ 3 N2 stations before PSM. After PSM, RFS remained comparable for margin distances ≥ 2.0 cm and ≥ 1 N1 stations. (Table 1) No significant difference was found in specific recurrence or cause of death between the two groups across all subgroups.
Conclusion: Segmentectomy offers superior survival compared to wedge resection for clinical stage IA NSCLC, with better resection margins, more extensive lymph node removal, and a lower recurrence rate. However, when margin distance and lymphadenectomy are optimized, wedge resection may achieve a comparable prognosis.
THORACIC:
Lung Cancer
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