Can cancer type influence limited resection in patients with non-small cell lung cancer?

This study aimed to determine whether a certain cancer type would affect the rate of survival after limited resection in patients with early stage non-small cell lung cancer (NSCLC). The authors concluded that limited resection is beneficial for patients with adenocarcinoma but they advise caution for patients with squamous cell carcinoma and other tumors.

For patients with early-stage NSCLC, surgery is considered the best option. A lobectomy is the most common procedure associated with early stage NSCLC, however this involves the removal of an entire lobe of the lung. While limited resection (removal of part of the lung) may therefore be less intense, previous studies have shown it is associated with a higher risk of the cancer returning. In contrast, other studies have shown  good survival statistics with limited resection if the tumor is very small. It is therefore possible that different NSCLC cancer pathologies (types) may influence whether limited resection would be beneficial or not.  These NSCLC types include adenocarcinoma, squamous cell carcinoma, and other types of tumors.

This study aimed to determine whether the effectiveness of limited resection was influenced by type of NSCLC.

The study involved an analysis of 1710 patients who had limited resection for early stage NSCLC. 1575 patients had adenocarcinoma, 100 patients had squamous cell carcinoma and 35 patients had other types of tumors. The average follow-up for patients was 71.6 months.

The 5-year disease free survival (DFS, time from treatment until cancer recurrence or death) rate was 90.9%. The 5-year recurrence free proportion (RFP, proportion of patients free from cancer recurrence regardless of survival or death) was 93.6%. There was no difference in DFS or RFP between cancer types.

For patients with adenocarcinoma, survival statistics after limited resection were good. For patients with squamous cell carcinoma, one type of limited resection known as segmentectomy gave better survival statistics than other types of limited resection. 5-year RFP for patients who had a segmentectomy was 85.5% compared to 65.5% for patients who had a different type of limited resection. For patients with large cell carcinomas, 5-year DFS and RFP was only 46.3%.

The authors concluded that limited resection is just as effective as larger resections for patients with early stage adenocarcinoma NSCLC. They also indicated that segmentectomy is preferable or patients with squamous cell carcinoma, and that limited resection is not advisable for patients with large cell carcinomas.