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Objective <p>The study aimed to evaluate the risk of unforeseen nodal upstaging (pN+) after pulmonary segmentectomy without intraoperative frozen section.</p> Methods <p>We conducted a retrospective analysis for consecutive patients who underwent segmentectomy for clinical stage IA1-2 non-small cell lung cancer (cIA1-2 NSCLC) in three centers between January 2017 and December 2022. A backward stepwise logistic regression analysis for variables with <i>P</i> &lt; 0.1 in univariable analysis was performed to predict pN+. Kaplan–Meier analysis with log-rank test evaluated the discrepancy for overall (OS) and recurrence-free survivals (RFS).</p> Results <p>Among 478 patients included in the final analysis, 19 (4.0%) had pN+, including 10 (2.1%) pN1, 6 (1.3%) pN2, and 3 (0.6%) pN1+2. With a median follow-up of 23.5&#xa0;months (interquartile range 12.6–39.0), patients with pN+ had poorer OS compared to those with pN0 (3-year OS: 70.2% vs. 89.7%, <i>P</i> = 0.002). However, there was no significant difference in RFS and recurrence. The maximum standardized uptake value (SUVmax) of tumor in positron emission tomography scan ≥ 4.5 (versus &lt; 4.5) was the only independent factor for pN + (odds ratio 3.5). Patients with a SUVmax ≥ 4.5 had 7.3% pN+, which was associated with poorer OS and similar RFS and recurrence compared to pN0. In contrast, those with a SUVmax &lt; 4.5 had 2.2% pN+, which had comparable recurrence and survival to pN0.</p> Conclusion <p>Unforeseen nodal upstaging in segmentectomy for cIA1-2 NSCLC is low. Frozen section of lymph nodes may be necessary for lesions with high metabolic activity.</p>

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Unforeseen nodal upstaging in patients undergoing segmentectomy without frozen section: a multicenter retrospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年2月13日

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  • Lin Huang,
  • Alessandro Brunelli,
  • Demetrios Stefanou,
  • Edoardo Zanfrini,
  • Abid Donlagic,
  • Michel Gonzalez,
  • René Horsleben Petersen

摘要

Objective

The study aimed to evaluate the risk of unforeseen nodal upstaging (pN+) after pulmonary segmentectomy without intraoperative frozen section.

Methods

We conducted a retrospective analysis for consecutive patients who underwent segmentectomy for clinical stage IA1-2 non-small cell lung cancer (cIA1-2 NSCLC) in three centers between January 2017 and December 2022. A backward stepwise logistic regression analysis for variables with P < 0.1 in univariable analysis was performed to predict pN+. Kaplan–Meier analysis with log-rank test evaluated the discrepancy for overall (OS) and recurrence-free survivals (RFS).

Results

Among 478 patients included in the final analysis, 19 (4.0%) had pN+, including 10 (2.1%) pN1, 6 (1.3%) pN2, and 3 (0.6%) pN1+2. With a median follow-up of 23.5 months (interquartile range 12.6–39.0), patients with pN+ had poorer OS compared to those with pN0 (3-year OS: 70.2% vs. 89.7%, P = 0.002). However, there was no significant difference in RFS and recurrence. The maximum standardized uptake value (SUVmax) of tumor in positron emission tomography scan ≥ 4.5 (versus < 4.5) was the only independent factor for pN + (odds ratio 3.5). Patients with a SUVmax ≥ 4.5 had 7.3% pN+, which was associated with poorer OS and similar RFS and recurrence compared to pN0. In contrast, those with a SUVmax < 4.5 had 2.2% pN+, which had comparable recurrence and survival to pN0.

Conclusion

Unforeseen nodal upstaging in segmentectomy for cIA1-2 NSCLC is low. Frozen section of lymph nodes may be necessary for lesions with high metabolic activity.