Do Pathologic Margins Matter in Anatomic Lung Resections?

273 

Abstract Submission 

Kunaal Sarnaik (1), Allison Gasnick (1), Aria Bassiri (2), Craig Jarrett (2), Jillian Sinopoli (2), Leonidas Tapias Vargas (2), Philip Linden (2), Christopher Towe (2)

(1) Case Western Reserve University School of Medicine, Cleveland, OH, (2) University Hospitals Cleveland Medical Center, Cleveland, OH

Kunaal Sarnaik    -  Contact Me
Case Western Reserve University School of Medicine

Allison Gasnick    -  Contact Me
Case Western Reserve University School of Medicine

Aria Bassiri    -  Contact Me
University Hospitals Cleveland Medical Center

Craig Jarrett    -  Contact Me
University Hospitals Cleveland Medical Center

Jillian Sinopoli    -  Contact Me
University Hospitals Cleveland Medical Center

Leonidas Tapias Vargas    -  Contact Me
University Hospitals Cleveland Medical Center

*Philip Linden    -  Contact Me
University Hospitals Cleveland Medical Center

Christopher Towe    -  Contact Me
University Hospitals Cleveland Medical Center

Kunaal Sarnaik    -  Contact Me
N/A

Objective: Close margin distance after wedge resection has been associated with lung cancer recurrence and death. The relationship between pathologic margin and recurrence has not yet been established after anatomic lung resection. We hypothesized that close pathologic margin after anatomic lung resection would not be associated with decreased overall survival.

Methods: Detailed pathology reports were extracted among patients receiving anatomic lung resection at a single institution between 2014-2021. Patients with "distance to closest margin" documented were included. Patients with pathologic metastatic disease were excluded. "Close" pathologic margin was defined as closest pathologic margin <1cm. The outcome of interest was overall survival defined as time from surgery to last follow up or death, which was calculated using state Death Record Indices. Kaplan-Meier survival estimates were performed using log rank test. Multivariable cox proportional hazard analysis was performed, including an interaction analysis, to evaluate close pathologic margin in each "extent of resection": lobectomy, segmentectomy, bilobectomy, pneumonectomy.

Results: Among 246 patients included in the study, 97 (39.4%) had a close pathologic margin. The average margin was 1.87cm (median 1.2cm, IQR 0.5-2.6cm). Close margin status did not vary by extent of resection, or nodal status, but was more likely with higher T-stage tumors (T1 36.8%, T2 28.6%, T3 58.8%, T4 66.7%, p=0.004). Median follow-up was 2.4 years and did not vary by margin status (p=0.399). Overall survival was not decreased among patients with a close margin (Figure 1, p=0.367). In a multivariable cox hazard analysis of overall survival, close margin was not associated with decreased overall survival (HR 0.457, p=0.087), while CHF (HR 4.45, p=0.002), T4 tumors (HR 8.67, p=0.001) and nodal metastasis (HR 4.90, p<0.001) were associated with decreased survival. A multivariable interaction analysis between anatomic margin and extent of resection did not demonstrate decreased survival associated with close pathologic margin among patients receiving segmentectomy (relative to >1cm margin and lobectomy – HR 0.356, p=0.345).

Conclusions: Close pathologic margins are not associated with increased risk of death after anatomic lung resections. In the setting of CALGB 140305, sublobar anatomic lung resection may be increasingly safely performed, and negative pathologic margins after segmentectomy are likely sufficient.

Lung Cancer