"The Lancet" is heavy: precise excision, better survival!

▎WuXi AppTec Content Team Editing Surgical treatment is one of the most important radical methods for early-stage lung cancer, and the most widely used operation includes lobectomy
.

With the advancement of imaging screening technology, the detection rate of early-stage lung cancer with smaller lesion diameter, such as peripheral small lung cancer (tumor diameter ≤ 2 cm), has increased significantly, so whether the resection range of early-stage lung cancer surgery can also be smaller ? Recently, the results of a Phase 3 clinical trial named JCOG0802/WJOG4607L were published in THE LANCET
.

The results of the study confirm that a more precise method of resection, segmentectomy (removal of only one segment of a patient's lung), may be more effective than lobectomy in improving overall survival in patients with early-stage lung cancer
.

The paper emphasizes that for patients with peripheral non-small cell lung cancer (NSCLC) with stage IA, tumor diameter ≤2 cm, and solid tumor ratio >0.
5, segmentectomy should replace lobectomy as the standard procedure for such patients.

.

Screenshot source: THE LANCET paper points out that lobectomy is the standard treatment for early-stage NSCLC
.

However, there is no randomized controlled trial to confirm whether segmentectomy can bring more obvious survival and clinical benefits to these patients
.

The JCOG0802/WJOG4607L trial was a randomized, controlled, non-inferiority trial involving 1106 patients from 70 medical centers in Japan (recruitment: August 10, 2009 to October 21, 2014)
.

The purpose of this study was to determine whether segmentectomy is noninferior to lobectomy for peripheral small lung cancer (tumor diameter ≤2 cm)
.

The enrolled patients were all clinical stage IA NSCLC (tumor diameter ≤2 cm; solid tumor ratio >0.
5), randomly assigned in a 1:1 ratio to receive lobectomy (n=554) or segmentectomy (n=552) )
.

Among them, 22 patients in the segmentectomy group underwent lobectomy; 1 patient underwent extensive wedge resection
.

The primary endpoint of the study was overall survival for all randomized patients
.

Secondary endpoints included postoperative respiratory function (6 and 12 months), recurrence-free survival, proportion of local recurrence, and adverse events
.

The results showed that with a median follow-up of 7.
3 years, the 5-year overall survival rates of patients who underwent segmentectomy and lobectomy were 94.
3% (92.
1–96.
0) and 91.
1%, respectively
.

Results of the analysis confirmed superiority and noninferiority for overall survival in patients who underwent segmentectomy compared with patients who underwent lobectomy (HR = 0.
663; 95% CI: 0.
474–0.
927; one-sided noninferiority).
In patients undergoing segmentectomy, a consistent improvement in overall survival was observed across all prespecified subgroups, including males, 70 years and older, solid tumors, non-adenocarcinomas 5-year recurrence-free survival rates were 88.
0% and 87.
9% for patients who underwent segmentectomy and lobectomy, respectively (HR = 0.
998; 95% CI: 0.
753–1.
323 ; p=0.
9889), in addition, the proportion of local recurrence in patients undergoing segmentectomy and lobectomy was 10.
5% and 5.
4%, respectively (p=0.
0018); after segmentectomy and lobectomy, the two groups of patients 47% (27/58) and 63% (52/83) died of other diseases, respectively.
No death was observed within 30 days or 90 days of treatment.
The incidence of postoperative complications of grade 2 or above was similar between the two groups
.

▲The overall survival rate of NSCLC patients who received different surgical procedures, the red and blue curves are patients who received segmentectomy and lobectomy respectively (Image source: Reference [1]) In general, segmentectomy is not only in the overall The efficacy in terms of survival was not inferior to lobectomy, and even showed superiority in terms of efficacy
.

The findings suggest that for clinical stage IA (tumor diameter ≤2 cm) peripheral-type (ie, tumor located in the field one-third of the lung) NSCLC, segmentectomy should be the standard surgical procedure for this patient population
.

Comments in the same period of the paper emphasized that the current study is "the first phase 3 clinical trial to demonstrate that segmentectomy can bring a greater overall survival benefit to patients with peripheral small lung cancer than lobectomy
.
"
The findings of the study have extremely significant significance, and may lead to a huge change in the standard treatment concept of early-stage NSCLC, and will greatly promote the clinical exploration of segmentectomy!