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Article Dans Une Revue European Journal of Cardio-Thoracic Surgery Année : 2023

Peripheral location of lung cancer is associated with higher local disease recurrence

Résumé

OBJECTIVES To evaluate the association between the distance of the tumour to the visceral pleura, and the rate of local recurrence in patient surgically treated for stage pI lung cancer. METHODS A single centre retrospective review of 578 subsequent patients with a clinical stage IA lung cancer who underwent lobectomy or segmentectomy from January 2010 to December 2019. Were excluded those 107 patients with either positive margins, previous lung cancer, neoadjuvant treatment, pathological stage II or higher status, or patients in whom preoperative CT-scan was not available at the time of the study. Distance between the tumour and the closest visceral pleura area (fissure/mediastinum/lateral) was assessed by two independent investigators, using the preoperative CT-scan and multiplanar 3D reconstructions. An AUC curve was performed to determine the best threshold for tumour/pleura distance, and then multivariable survival analyses to assess the relationship between local recurrence and this threshold adjusting on other variables. RESULTS Local recurrence occurred in 27/471 patients (5.8%). A cut-off value of 5 mm between the tumour and the pleura was statistically determined. In multivariable analysis, local recurrence rate was significantly higher in patients with tumour-to-pleura ≤5mm, compared to patients with tumour-to-pleura >5mm (8.5% vs 2.7%, HR 3.36, 95% CI: 1.31–8.59, p = 0.012). Sub-group analyses regarding patients with pIA and tumour size ≤2cm found local recurrence in 4/78 patients treated with segmentectomy (5.1%), with a significant higher occurrence in tumour-to-pleura ≤5mm (11.4% vs 0%, p = 0.037), and in 16/292 patients treated with lobectomy (5.5%) without significant higher occurrence in tumour-to-pleura ≤5mm (7.7% vs 3.4%, p = 0.13). CONCLUSIONS Peripheral location of lung tumour is associated with a higher rate of local recurrence and should be taken into account during preoperative planning when considering segmental versus lobar resection.
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Dates et versions

hal-04061420 , version 1 (06-04-2023)

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Alex Fourdrain, Vassili Anastay, Vanessa Pauly, Cesare Braggio, Xavier-Benoit d'Journo, et al.. Peripheral location of lung cancer is associated with higher local disease recurrence. European Journal of Cardio-Thoracic Surgery, 2023, ⟨10.1093/ejcts/ezad130⟩. ⟨hal-04061420⟩
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