110. Segmentectomy Versus Lobectomy in Small-Sized Peripheral Non-small Cell Lung Cancer with Radiologically Pure-solid Appearance: Supplemental Analysis of JCOG0802/WJOG4607L

Objective:
JCOG0802/WJOG4607L showed the improved OS of segmentectomy especially in patients with radiological pure-solid NSCLC, despite the high malignant feature compared to part-solid one. However, the clinical reasons are not completely clarified. Therefore, we conducted a supplemental analysis to investigate the survival of segmentectomy compared to lobectomy for NSCLC with pure-solid appearance on thin-section CT.
Methods:
Among the 1106 patients registered in JCOG0802/WJOG4607L, survival outcomes, causes of death or recurrence in 553 pure-solid tumors were compared between segmentectomy and lobectomy arms.
Results:
Lobectomy was assigned to 274 and segmentectomy to 279 patients. Nodal metastasis was found in 57 (10.4%). The 5-year OS was significantly better in the segmentectomy compared to the lobectomy (92.4% vs. 86.1%, HR 0.641, log-rank test p=0.0333), while the 5-year RFS was similar between the two arms (82.0% vs. 81.7%, HR 1.013, p=0.9420). Lung cancer death was 20 (7%) in the lobectomy and 19 (7%) in the segmentectomy, while 33 (12%) in the lobectomy died of other diseases compared to 16 (6%) in the segmentectomy. In contrast, locoregional recurrence was 2.3-folds higher in the segmentectomy, which was significantly different from the lobectomy (45 (16%) vs. 21 (8%), p=0.0021). In multivariable Cox regression analysis, lobectomy, ≥70 years old, CEA of ≥5.0 ng/ml, and non-adenocarcinoma were significantly associated with the worse OS (p<0.05, respectively), while ≥70 years old and non-adenocarcinoma were still significant for the worse RFS but surgical mode was not associated (p=0.8427). Hence, provided that the survival outcomes were stratified by the age, the results in patients ≥70 years old were similar to those of the entire cohort (OS: 85.6% vs. 77.1%, p=0.0134, RFS: 78.4% vs. 73.6%, p=0.0712). In patients <70 years old, however, the RFS of segmentectomy was significantly worse compared to lobectomy (84.4% vs. 87.4%, p=0.0493) but the OS was not statistically different between the two arms (97.0% vs. 92.5%, p=0.8386).
Conclusions:
JCOG0802/WJOG4607L supplemental analysis showed improved OS of segmentectomy in radiological pure-solid NSCLC. However, the survival benefit of segmentectomy differs based on the age. Since higher locoregional recurrence may contribute to the worse RFS of segmentectomy in younger patients, further evaluations are necessary to clarify the clinical significance of segmentectomy for pure-solid NSCLC.

Aritoshi Hattori (1), Kenji Suzuki (1), Kazuya Takamochi (1), Masashi Wakabayashi (2), Tomoko Kataoka (3), Atsushi Kamigaichi (4), Tomohiro Miyoshi (5), TAKAHIRO MIMAE (6), Mitsuhiro Isaka (7), Makoto Endoh (8), Hiroshige Yoshioka (9), Yasuhiro Tsutani (10), Hiroyuki Ito (11), Kazuo Nakagawa (12), Jiro Okami (13), Ryu Nakajima (14), keiju aokage (5), Hisashi Saji (15), Masahiro Tsuboi (5), Morihito Okada (6), Hisao Asamura (16), Shun-ichi Watanabe (12), (1) Juntendo University Hospital, Tokyo, (2) Japan Clinical Oncology Group (JCOG) Data Center/Operations Office, National Cancer Center Hospital, Chiba, (3) Japan Clinical Oncology Group (JCOG) Data Center/Operations Office, National Cancer Center Hospital, Tokyo, (4) Hiroshima University Hospital, Japan, (5) National Cancer Center Hospital East, Chiba, (6) Hiroshima University Hospital, Hiroshima, (7) Shizuoka Cancer Center Hospital, Shizuoka, (8) Yamagata Prefectural Central Hospital, Yamagata, (9) Kansai Medical University Hospital, Osaka, (10) Kindai University Faculty of Medicine, Osaka, (11) Kanagawa Cancer Center, Yokohama, (12) National Cancer Center Hospital, Tokyo, (13) Osaka International Cancer Institute, Osaka, (14) Osaka City General Hospital, Osaka, (15) St. Marianna University School of Medicine, Kanagawa, (16) Keio University Hospital, Tokyo

Scott Swanson

Invited Discussant

Dr. Scott J. Swanson is a thoracic surgeon and director of Minimally Invasive Thoracic Surgery at Brigham and Women’s Hospital. He is associate chief of surgery at Dana-Farber/Brigham and Women’s Cancer Center and is a professor of surgery at Harvard Medical School.

Dr. Swanson received his medical degree from Harvard Medical School and completed his general and cardiothoracic surgical residencies at the Brigham. He completed a fellowship in vascular biology at Harvard Medical School and a thoracic oncology fellowship at the Brigham. Dr. Swanson is board certified in surgery and thoracic surgery. He has been listed as one of America’s Top Doctors by Castle Connolly and named a top thoracic surgeon by Boston Magazine.

Dr. Swanson’s clinical interests include minimally invasive thoracic surgery and lung cancer. His research is focused on better understanding early stage lung cancer, its biologic fingerprint and clinical behavior.

Aritoshi Hattori

Abstract Presenter

Name:      Aritoshi Hattori, M.D.     Age:    44 years old  

Position Title:    Associate professor, Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo

Education:     National Defense Medical Collage, Saitama, Japan, graduated in 2005

Professional Training and Clinical Experience:

Assistant professor, Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, 2016-2018

General Thoracic Ward director, Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, 2018-

Associate professor, Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, 2019-

Representative committee of JCOG Lung Cancer Study Group, Japan, 2022-

Awards:

Award of the Japanese Association of the Chest Surgery, 2017

Research fields:

Thoracic Surgery and Oncology

Small-sized lung cancer, especially in the fields of the approptiate operative mode, prognosticator, radiological findings (CT or PET), and clinical Tstaging

Radiological findings of early-stage NSCLC based on the presence of a Ground-glass opacity (GGO) component on thin-section CT scan

Published papers:

40 paper, in the field of small-sized or early stage NSCLC

Specialties: General Thoracic, Thoracic, Procedures, Anatomy and Conditions, Lung--Cancer, Treatment/Procedure/Operation/Surgery, Lung--Cancer