Characteristics and risk factors of recurrence in clinical stage I non-small cell lung cancer patients undergoing anatom
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ORIGINAL ARTICLE
Characteristics and risk factors of recurrence in clinical stage I non‑small cell lung cancer patients undergoing anatomic segmentectomy Terumoto Koike1 · Akihiro Nakamura1 · Yuki Shimizu1 · Tatsuya Goto1 · Seijiro Sato1 · Shin‑ichi Toyabe2 · Masanori Tsuchida1 Received: 5 December 2019 / Accepted: 11 March 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objective Although lobectomy is the standard surgical procedure for small-sized non-small cell lung cancer (NSCLC), segmentectomy has been performed for various reasons. The aim of this study was to investigate the characteristics of and risk factors for recurrence in early-stage NSCLC patients undergoing segmentectomy. Methods We retrospectively reviewed 179 patients with clinical stage I NSCLC who underwent segmentectomy. Preoperative factors were analyzed using the log-rank test for univariate analyses. Multivariate analyses were performed using a Cox proportional hazards regression model to identify independent risk factors for recurrence. For the significant factors, optimal cutoff points were determined by receiver operating characteristic (ROC) analysis. Results During the follow-up period of 51 months, 18 patients developed recurrence; 5 had locoregional (including 2 with margin recurrences only), 9 had distant, and 4 had both locoregional and distant recurrence. Multivariate and ROC analysis identified radiologic solid tumor size with a cutoff point of 1.5 cm as an independent risk factor for recurrence. Three patients in the solid size 70 years), sex, smoking status (Brinkman index [BI] [14]; 0, > 0–600, or > 600), preoperative serum carcinoembryonic antigen (CEA) level ( 2–5 cm), size of the solid component on CT (≤ 1 or > 1 cm), consolidation/tumor size ratio (Cons/Tumor ratio) [15] on CT (≤ 50 or > 50%), diseased side (right or left), tumor location (upper lobe, superior segment [S6], or basal segment), reason for sublobar resection (lobectomy intolerable or intentional), number of resected segments (single or multiple), segmentectomy type (simple or complex) [16], extent of lymphadenectomy (sampling or systematic mediastinal lymphadenectomy), and tumor histology (adenocarcinoma, squamous cell carcinoma, or other cell types). The recurrence-free probability (RFP) was measured from the date of surgery to the date of detection of the first recurrence or the date of last follow-up. For the univariate analyses, the RFP was calculated using the Kaplan–Meier method. The preoperative factors identified as significant by the log-rank test in the univariate analyses were entered into a Cox proportional regression hazard model for multivariate analysis. A stepwise selection method was used to identify the risk factors for recurrence. Dichotomized data were used only for continuous variables in the univariate analysis. For factors significant in the multivariate analysis, a receiver operating characteristic (ROC) analysis was performed. The optimal cutoff points were evaluated by Youden’s index. p values of less than 0.05
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