Thoracic Surgery Fellow University of Pittsburgh Medical Center Pittsburgh, Pennsylvania, United States
Disclosure(s):
Yota Suzuki, MD: No financial relationships to disclose
Purpose: Large-cell neuroendocrine cancer (LCNEC) is a rare tumor histology associated with poor prognosis. Despite this, current guidelines categorize it alongside non-small cell cancer, raising challenges in its management. This study aims to analyze outcomes with sublobar resection in patients with clinical T1N0M0 LCNEC ( < 3 cm) compared to lobectomy. Methods: We performed a single-institution, retrospective study comparing patients undergoing sublobar resection (segmentectomy or wedge resection) versus lobectomy for clinical T1N0M0 LCNEC and mixed pathology with NSCLC, from January 1, 2002, to December 31, 2022. We performed unmatched comparisons and propensity-matched comparisons. Cohorts were matched in a 1:1 ratio on sex, age, tumor size, FEV1%, and Charlson comorbidity index. Kaplan-Meier analyses of overall survival and recurrence-free survival were performed for unmatched and matched cohorts. Results: During the study period, 62 lobectomies and 34 sublobar resections (20 segmentectomies and 14 wedge resections) were performed for clinical T1N0M0 LCNEC. Correct pre-/intraoperative histologic diagnosis was made only for 21 patients in lobectomy (33.9%) and 10 patients in sublobar resection (29.4%). The patients who underwent sublobar resection had higher Charlson comorbidity index (Median: 3 vs 2; p=0.006), lower FEV1/FVC (64.0% vs 69.0%; p=0.035), and smaller tumor size (1.5 vs 2.0 cm; p=0.002). Occult lymph node metastasis (N1) was detected only in lobectomy (11 patients; 17.7%), with a higher number of lymph node sampling in lobectomy (17; vs 5 in sublobar resection; p< 0.001). In the unmatched cohort, there was no difference in the median overall survival (65.4 vs 65.6 months; p=0.133) nor in median recurrence-free survival (31.1 vs 36.9 months; p=0.210) between sublobar resection and lobectomy. Sublobar resection was associated with a higher rate of locoregional recurrence (44.1% vs 14.5%; p=0.003), while the overall recurrence rate was not significantly different (50.0% vs 37.1%; p=0.280). In the successfully matched cohort with 22 patients in each arm, there was no difference in the median overall survival (65.6 vs 57.8 months; p=0.308) and median recurrence-free survival (27.1 vs 20.4 months; p=0.290; Figure). Conclusion: For cT1N0M0 LCNEC, sublobar resection was associated with a higher locoregional recurrence rate, while it did not lead to a significant survival difference in the cohort. Diagnosis of LCNEC is frequently detected after resection, raising a challenge for patients treated with sublobar resection, and an individualized approach is warranted.
Identify the source of the funding for this research project: NA
