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Central Surgical Association

49th Annual Meeting

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Occult Satellite Tumor Nodules following Lobectomy for Clinical Stage Ia Non-small Cell Lung Cancer- How frequent are they and can we predict them?
Peter Kneuertz1, Mahmoud Abdel-Rasoul2, Desmond M. D'Souza1, *Susan D. Moffatt-Bruce3, *Robert E. Merritt1
1Thoracic Surgery Division, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States, 2Biomedical Informatics, Ohio State University, Columbus, Ohio, United States, 3Royal College of Surgeons and Physicians, Ottawa, Quebec, Canada

Objective: The frequency of occult satellite nodules in early-stage non-small cell lung cancer (NSCLC) is currently ill-defined, and may have implications for patients considered for sublobar resection. We sought to assess the incidence and clinical predictors of tumor upstaging due to separate tumor nodules in patients undergoing lobectomy for clinical stage Ia disease.
Methods: The National Cancer Database was queried for patients who underwent lobectomy or bilobectomy for clinical stage Ia (cT1N0) NSCLC. Collaborative staging information was used to identify patients who were pathologically upstaged (pT3 or pT4) based on having separate tumor nodules in the same or different lobe of the ipsilateral lung. Binary logistic regression was used to assess the association of clinical factors with the detection of separate nodules.
Results: A separate tumor nodule was recorded in 3.2% (n=1,484) of 46,032 clinical stage Ia patients treated with lobectomy. The majority of separate nodules were detected the same lobe (pT3, 2.7%) and few in a different ipsilateral lobe (pT4, 0.5%). Female gender (3.5 % vs. male 2.9%; p=0.001) and non-squamous histology (adenocarcinoma 3.6% and large cell neuroendocrine 3.4% vs. squamous cell 1.9% tumors; p<0.001) were associated with the presence of separate nodules. The frequency increased significantly for tumors larger than 3 cm (<1cm 3.1% vs. 1-<3cm 3.1% vs. >3cm 4.8%; p<0.001). Other tumor factors associated with separate tumor nodules were the presence of pleural and/or lymphovascular invasion. The best predictive multivariate model for separate nodules based on the available clinical variables (Figure) resulted in an area under the curve of 0.648 (95% confidence interval 0.634-0.662).
Conclusion: Separate tumor nodules may be detected with a low but relatively consistent frequency across the spectrum of patients with clinical stage Ia NSCLC. The predictive ability using basic clinical factors in the database is moderate, and the value of radiographic and molecular predictors should be further explored. Consideration of occult satellite nodules may be important when selecting patients for sublobar resection.


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