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Importance of avoiding surgery delays after initial discovery of suspected non-small-cell lung cancer in clinical stage IA patients

Authors Kuroda H, Sugita Y, Ohya Y, Yoshida T, Arimura T, Sakakura N, Hida T, Yatabe Y, Sakao Y

Received 19 July 2018

Accepted for publication 29 October 2018

Published 20 December 2018 Volume 2019:11 Pages 107—115


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Antonella D'Anneo

Hiroaki Kuroda,1 Yusuke Sugita,1 Yuko Ohya,2 Tatsuya Yoshida,2 Takaaki Arimura,1 Noriaki Sakakura,1 Toyoaki Hida,2 Yasushi Yatabe,3 Yukinori Sakao1

1Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan; 2Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Japan; 3Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan

Introduction: The natural history of consolidation on computed tomography (CT) rarely includes invasive cancers, and evidence of the ideal timing for surgical intervention via long-term follow-up studies remains unknown.
Methods: Between January 2012 and June 2017, pulmonary resection was undertaken in 293 clinical IA patients who were followed-up for > 6 months after the first detection of potential non-small-cell lung cancer (NSCLC) opacities. We evaluated the corresponding HRs and compared the recurrence risk with the CT follow-up duration.
Results: HRs calculated for the longest intervals were compared between two patient subsets: a shorter-interval surgery group (SISG: 41.3%; mean follow-up interval, 13.5±5.3 months) and a longer-interval surgery group (58.7%; mean follow-up interval, 54.9±25.6 months). On Cox multivariate regression analyses, CT consolidation (ratio >0.5), an abnormal carcinoembryonic antigen and a triple-negative mutation showed an independent association with an unfavorable prognosis, as measured by disease-free survival after the first detection of potential NSCLC opacities. The longer-interval surgery group fared significantly better than the SISG in terms of 5-year overall survival after the first detection (99.3%  vs 93.1%, P<0.01); the 3-year overall survival after the first detection was significantly shorter in the high-risk SISG (presence of two factors from the three) than that in the low-risk SISG (presence of 0 or one factor; 100%  vs 73.3%, P<0.01).
Our study indicates that the patients with potential NSCLC opacities who are able to wait for more than 2 years prior to pulmonary resection may be likely to have a favorable prognosis, whereas early judgment for surgical resection should be required for avoiding surgical delays.

Keywords: non-small-cell lung cancer, computed tomography, natural history, surgery delay, consolidation, ground glass opacity

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