Abstract
Introduction
We sought to assess the prevalence and clinical predictors of satellite nodules in
patients undergoing lobectomy for clinical stage Ia disease.
Patients and Methods
The National Cancer Database was queried for patients who underwent lobectomy for
clinical stage cT1N0 NSCLC. Collaborative staging information was used to identify
patients who were pathologically upstaged based on having separate tumor nodules in
the same lobe as the primary tumor. Multivariable logistic regression was used to
assess the association of clinical factors with the detection of separate nodules.
Results
A separate tumor nodule was recorded in 2.8% (n = 1284) of 45,842 clinical stage Ia
patients treated with lobectomy or bilobectomy. Female gender (3.1% vs. male 2.5%;
P = .002) and non-squamous histology (adenocarcinoma 3.2% and large cell neuroendocrine
3.0% vs. squamous cell 1.9% tumors; P < .001) were associated with the presence of separate nodules. The frequency increased
for tumors larger than 3 cm (≤ 3cm, 2.7% vs. > 3cm, 3.8%; P < .001). Other factors associated with separate nodules were upper lobe location,
pleural and/or lymphovascular invasion and occult lymph node disease. The best predictive
model for separate nodules based on the available clinical variables resulted in an
area under the curve of 0.645 (95% CI 0.629-0.660).
Conclusion
Separate tumor nodules may be detected with a low but relatively consistent frequency
across the spectrum of patients with clinical stage Ia NSCLC. The predictive ability
using basic clinical factors in the database is limited.
Keywords
Abbreviations:
AJCC (American Joint Committee on Cancer), AUC (area under the receiver operating characteristic curve), COC (Commission on Cancer), CONSORT (Consolidated Standards of Reporting Trials), CT (Computed tomography), NCDB (National Cancer Database), NSCLC (Non-small cell lung cancer), PET-FDG (Fluorodeoxyglucose positron emission tomography)To read this article in full you will need to make a payment
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References
- Prognostic factors in resected satellite-nodule T4 non-small cell lung cancer.Ann Thorac Surg. 2007; 84 (discussion 939): 934-938
- Carcinoma of the lung. Evaluation of satellite nodules as a factor influencing prognosis after resection.J Thorac Cardiovasc Surg. 1989; 97: 504-512
- The eighth edition lung cancer stage classification.Chest. 2017; 151: 193-203
- Surgical resection for multifocal (T4) non-small cell lung cancer: is the T4 designation valid?.Ann Thorac Surg. 2007; 83: 397-400
- Resection of pulmonary metastasis of non-small cell lung cancer.J Thorac Oncol. 2009; 4: 203-207
- Segmentectomy for clinical stage I non-small cell lung cancer: National benchmarks for nodal staging and outcomes by operative approach.Cancer. 2022; 128: 1483-1492
- Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial.Clin Oncol. 2022; 399 (Lancet): 1607-1617
- Adjuvant chemotherapy for T3 non-small cell lung cancer with additional tumor nodules in the same lobe.J Thorac Oncol. 2016; 11: 1090-1100
- Characteristics and outcomes of secondary nodules identified on initial computed tomography scan for patients undergoing resection for primary non-small cell lung cancer.J Thorac Cardiovasc Surg. 2015; 149: 19-24
- Coexisting pulmonary nodules in operable lung cancer: prevalence and probability of malignancy.Lung Cancer. 2011; 74: 233-238
- The probability of malignancy in small pulmonary nodules coexisting with potentially operable lung cancer detected by CT.Eur Radiol. 2003; 13: 2447-2453
- Therapeutic strategy in patients with non-small cell lung cancer associated to satellite pulmonary nodules.Eur J Cardiothorac Surg. 2002; 21: 1100-1104
- Small pulmonary nodules on CT accompanying surgically resectable lung cancer: likelihood of malignancy.J Thorac Imaging. 2002; 17: 40-46
- Small satellite pulmonary nodules in operable lung cancer: diagnosis and therapeutic strategy.J Cancer Res Ther. 2014; 2: 111-115
- Pulmonary tumorlets: CT findings.AJR Am J Roentgenol. 2004; 183: 293-296
- Histopathologic and molecular approach to staging of multiple lung nodules.Transl Lung Cancer Res. 2017; 6: 540-549
Article info
Publication history
Published online: December 27, 2022
Accepted:
December 20,
2022
Received in revised form:
December 5,
2022
Received:
September 19,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Presented at the 48th Annual Western Thoracic Surgical Association Meeting, June 25th, 2022, in Koloa, Hawaii
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
