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Idiopathic pulmonary fibrosis guidelines changed the high-resolution computed tomography (HRCT) pattern from 3 to 4 categories in 2018. We assessed the relationship between surgical outcomes and HRCT patterns according to the 2018 guidelines. Among 1503 patients who underwent pulmonary resection for clinical stage Ⅰ to stage Ⅲ lung cancer at our institution between April 2007 and June 2019, we retrospectively investigated 218 with interstitial lung abnormalities based on preoperative HRCT. We reclassified all interstitial lung abnormality cases with preoperative HRCT from 3 patterns—usual interstitial pneumonia (UIP), possible, and inconsistent with UIP—of the previous (2011) guidelines to 4 patterns—UIP, probable UIP, indeterminate, and alternative diagnosis—according to the new consensus guideline of idiopathic pulmonary fibrosis (2018). The occurrence of acute exacerbations and survival were analyzed, and the association with HRCT pattern was investigated. Interstitial lung abnormality cases were reclassified as UIP (n = 55 [25.2%]), probable UIP (n = 36 [16.5%]), indeterminate UIP (n = 56 [25.7%]), and alternative diagnosis (n = 71 [32.6%]). Acute exacerbations developed in 21 patients (UIP pattern, n = 9 [16.4%]; probable UIP, n = 5 [13.9%]; indeterminate, n = 3 [5.4%]; and alternative diagnosis, n = 4 [5.6%]). Multivariable Cox regression revealed that UIP pattern or probable UIP pattern of the 2018 guideline was an independent risk factor for severe acute exacerbations (grade III-Ⅴ; odds ratio, 6.81; 95% CI, 1.42-32.60) and postoperative overall survival (hazard ratio, 3.12; 95% CI, 1.70-5.73). UIP and probable UIP patterns were risk factors for postoperative severe acute exacerbations and death. The HRCT patterns of the 2018 guidelines can stratify outcomes of lung resection. [Display omitted] [ABSTRACT FROM AUTHOR]

This study aimed to investigate the efficacy of adjuvant chemotherapy for pathologic stage I non-small cell lung cancer (NSCLC) with high risk for recurrence. Prospectively collected data from 1278 patients with pathologic stage I NSCLC according to eighth edition staging guidelines who were undergoing lobectomy were retrospectively analyzed. Factors associated with high risk for recurrence were determined using the multivariable Cox proportional hazards model for recurrence-free survival (RFS). Survival was compared between patients who received adjuvant chemotherapy and those who did not. In multivariable analysis, age (≥70 years), invasive component size (>2 cm), visceral pleural invasion, lymphatic invasion, and vascular invasion were identified as independent factors for RFS. In patients with high-risk factors for recurrence such as pathologic T1c or T2a or lymphovascular invasion (high-risk group; n = 641), adjuvant chemotherapy resulted in significantly longer RFS and overall survival (n = 222; 5-year RFS, 81.4%; 5-year overall survival, 92.7%) than in patients who did not receive adjuvant chemotherapy (n = 418; 5-year RFS, 73.8%; P =.023; 5-year overall survival, 81.7%; P <.0001). In patients without any high-risk factors for recurrence (low-risk group; n = 637), RFS was not significantly different between those who received adjuvant chemotherapy (n = 83; 5-yeat RFS, 98.1%) and those who did not (n = 554; 5-year RFS, 95.7%; P =.30). Adjuvant chemotherapy may improve survival in patients with pathologic stage I NSCLC who have factors associated with high risk for recurrence, such as pathologic T1c or T2a or lymphovascular invasion. [Display omitted] [ABSTRACT FROM AUTHOR]

In lung cancer patients with interstitial lung disease (ILD) postoperative acute exacerbation can be fatal. However the predictive biomarkers for postoperative exacerbation of ILD have not been fully elucidated. The soluble receptor for advanced glycation end products is a lung-derived antiinflammatory protein that can prevent acute lung injury. This study aimed to elucidate its role in this fatal complication, especially focusing on the predictive potential of serum levels of soluble receptor for advanced glycation end products. We retrospectively enrolled 152 patients with lung cancer and ILD who underwent lung resection and had blood samples collected before surgery. Independent predictors of postoperative acute exacerbation were evaluated in all patients and in subgroups based on the surgical procedure. Additionally serial changes in soluble receptor levels in these subgroups were evaluated. Seventeen patients (11.2%) developed postoperative acute exacerbation. Receiver operating characteristic curve analysis revealed 547.4 pg/mL as the optimal soluble receptor level cutoff value. Univariate and multivariate logistic regression analyses revealed a significant association between soluble receptor serum levels (≤547.4 pg/mL) and postoperative acute exacerbation. In the subgroup analysis this independent association was observed only in the lobectomy group. Additionally lobectomy caused a significant reduction in postoperative soluble receptor levels. Decreased baseline levels of circulatory soluble receptor might be a potential risk factor for postoperative acute exacerbation in patients with lung cancer and ILD. Moreover additional reduction in the levels of this antiinflammatory protein occurs because of lung resection. [ABSTRACT FROM AUTHOR]

Due to its invasiveness, the indications for "complex segmentectomy" for radiologically hypermetabolic (high maximum standard uptake value) non-small cell lung cancer (NSCLC) remain controversial. This study compared the outcomes after complex segmentectomy and lobectomy in these patients. We retrospectively reviewed 717 patients with radiologically hypermetabolic (maximum standardized uptake value ≥2.5), clinical stage IA NSCLC who underwent complex segmentectomy (n = 61) or location-adjusted lobectomy (n = 656) at three institutions from 2010 to 2019. Postoperative outcomes were analyzed for all patients and their propensity score matched pairs. Factors affecting oncologic outcomes were assessed by Kaplan-Meier estimates and Cox proportional hazards regression analyses. The prognosis of patients undergoing complex segmentectomy was not significantly different from that of patients undergoing lobectomy (5-year cancer-specific survival rate, 89.9% vs 91.1%, P =.98; and 5-year recurrence-free interval rate, 83% vs 77.5%, P =.62) in the nonadjusted cohort. In 55 propensity score matched pairs, oncologic outcomes were not significantly different between patients undergoing complex segmentectomy (5-year cancer-specific survival, 89.9%; 5-year recurrence-free interval, 83%) and lobectomy (5-year cancer-specific survival, 83.6%; 5-year recurrence-free interval, 82.5%). Multivariable Cox regression analysis for recurrence-free interval revealed no significant differences between oncologic outcomes associated with complex segmentectomy and lobectomy (hazard ratio, 0.84; 95% confidence interval, 0.25 to 2.14; P =.74). Oncologic outcomes of complex segmentectomy and lobectomy were not significantly different for patients with radiologically hypermetabolic, clinical stage IA NSCLC patients. Complex segmentectomy can treat high maximum standardized uptake value, clinical stage IA lung cancers without compromising oncologic results. [Display omitted] [ABSTRACT FROM AUTHOR]

This study aimed to investigate the prognosis after segmentectomy as compared with lobectomy for small-sized lung adenocarcinoma with spread through air spaces (STAS). This retrospective study included 609 patients who underwent lobectomy or segmentectomy with lymph node dissection for clinical stage IA lung adenocarcinoma between April 2011 and March 2020 at Hiroshima University Hospital. Patient characteristics and prognosis after segmentectomy and lobectomy were investigated. STAS was detected in 293 patients (48.1%). The recurrence-free survival (RFS) rate was significantly worse with STAS-positive adenocarcinoma than with STAS-negative adenocarcinoma both in patients who underwent lobectomy (5-year RFS, 68.2% vs 90.2%; P <.001) and in patients who underwent segmentectomy (5-year RFS, 81.3% vs 93.0%; P =.003). Among the patients with STAS, there was no significant difference in RFS between patients who underwent lobectomy (5-year RFS, 68.2%) and those who underwent segmentectomy (5-year RFS, 81.3%; P =.225). In a multivariable analysis using propensity score to adjust clinical patient characteristics, segmentectomy was not found to be an independent prognostic factor of RFS (hazard ratio 0.732, P =.326) among patients with STAS. Among the patients with STAS, only 1 patient (1%) with insufficient resection margin (0.5 mm) had local recurrence and 1 patient (1%) with invasive mucinous adenocarcinoma had recurrence in preserved lobe after segmentectomy. Spread through air spaces was a poor prognostic factor in patients with clinical stage IA lung adenocarcinoma. Prognosis after segmentectomy was comparable with that of lobectomy in lung adenocarcinoma with STAS without increasing locoregional recurrence. [ABSTRACT FROM AUTHOR]

Acute exacerbation (AE) of interstitial pneumonia (IP) is a fatal complication after lung resection. We aimed to investigate whether the visual accumulation of [18F]-fluoro-2-deoxy-D-glucose (FDG) in the field of IP on preoperative FDG-positron emission tomography–computed tomography is useful for predicting AE of IP. This study included 193 patients with IP findings on preoperative computed tomography who underwent curative intent lung resection for primary lung cancer at Hiroshima University Hospital between April 2007 and March 2019. If the uptake of IP area was higher than the background normal lung, the patients were considered to have positive FDG accumulation. The relationship of the accumulation of FDG in the IP area and the incidence of AE of IP and short-term mortality was analyzed. Among the included patients, accumulation of FDG in the IP area was detected in 130 (67.4%) patients. The incidence of AE of IP was significantly different between patients with (10.0%) and without (0%) FDG accumulation in the IP area (P =.001). The 90-day mortality rate was also significantly different between patients with (6.9%) and without (0%) accumulation of FDG in the IP area (P =.007). In the multivariable analysis, the accumulation of FDG in the IP area was a significant risk factor of AE of IP (P =.005). The visual evaluation of accumulation of FDG in the IP area was useful to predict the AE of IP and short-term mortality after lung resection. [Display omitted] [ABSTRACT FROM AUTHOR]

Complex segmentectomy creates several intricate intersegmental planes; however, it has not been fully established in lung cancer treatment. We compared the oncologic outcomes of complex segmentectomy and lobectomy through a large cohort, multicenter database using propensity score-matched analysis. We retrospectively analyzed data from 1517 patients with clinical stage I lung cancer with a solid component size 2.0 cm or less, who underwent surgical resection at 3 institutions between 2010 and 2018. Complex segmentectomy (n = 240) and location-adjusted lobectomy (n = 851) as well as surgical results were analyzed for all patients and their propensity score-matched pairs. The prognosis of patients undergoing complex segmentectomy was not significantly different from that of patients undergoing lobectomy (5-year cancer-specific survival [CSS] rate, 96.4% versus 97.2%, P =.69; and 5-year recurrence-free interval [RFI] rate, 95.8% versus 93.4%, P =.19). This trend was also identified in subanalyses for pure solid tumors. However, there were major differences in clinicopathologic features between the 2 groups. After propensity score-matched analysis, proper matching of patients was ascertained. In 219 propensity score-matched pairs, long-term outcomes were similar between patients undergoing complex segmentectomy (5-year CSS, 96.0%; 5-year RFI, 95.5%) and lobectomy (5-year CSS, 97.8%; 5-year RFI, 95.9%). Propensity score-adjusted multivariable analysis for RFI revealed that prognosis associated with complex segmentectomy was comparable to the prognosis obtained with lobectomy (hazard ratio = 0.98; 95% confidence interval, 0.33-2.40; P =.98). Complex segmentectomy provides acceptable oncologic outcomes in clinical stage I lung cancer treatment. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the efficacy of the Deauville criteria, 5-point semiquantitative scale criteria to assess the maximum standardized uptake value of [18F]-fluoro-2-deoxy- d -glucose (FDG) on positron emission tomography (PET)–computed tomography (CT), in predicting lymph node metastasis and other pathological invasive characteristics of early-stage lung adenocarcinoma. In this retrospective study including 453 patients undergoing lobectomy or segmentectomy with lymph node dissection for clinical T1 or Tis N0 adenocarcinoma between April 2011 and March 2019, the FDG-PET/CT scans were evaluated using Deauville criteria to analyze the relationship of the Deauville score with the clinicopathological characteristics and prognosis. The lymph node metastases were present in 0 (0%), 2 (1.1%), 6 (9.5%), 6 (15.8%), and 13 (15.7%) patients with Deauville scores of 1, 2, 3, 4, and 5, respectively. The pathological invasive characteristics (lymphatic, vascular, or visceral pleural invasion) were detected in 2 (2.4%), 17 (9.9%), 18 (28.6%), 23 (60.5%), and 54 (65.1%) patients with a Deauville score of 1, 2, 3, 4, and 5, respectively. The 3-year recurrence-free survival was longer in patients with a Deauville score of 1 to 2 (97.2%) than those with a Deauville score of 3 (86.2%; P <.001) or 4 to 5 (80.7%; P <.001). The 5–point scale evaluation of the maximum standardized uptake value on FDG-PET/CT using the Deauville score was useful in predicting not only lymph node metastasis but also other malignant features of early-stage lung adenocarcinoma. [ABSTRACT FROM AUTHOR]

The prognosis of patients with cT1N0 lung adenocarcinoma is better when tumors include mixed ground glass opacity (GGO), compared with pure solid tumors. However, whether the prognosis of patients with mixed GGO tumors is favorable regardless of the solid component size remains unknown. Therefore, we aimed to determine the prognostic role of the solid component size in mixed GGO. We retrospectively analyzed the clinicopathological findings and prognoses of 856 patients with mixed GGO tumors based on solid component size during a median follow-up of 45 months, among 1215 patients with cT1N0 lung adenocarcinoma according to the TNM Classification of Malignant Tumors, Eighth Edition, who underwent R0 resection at 3 institutions between 2010 and 2015. Four-year recurrence-free survival rates were significantly worse for patients with mixed GGO cT1c tumors (solid component size: 2-3 cm; 81.5%; 95% confidence interval [CI], 72.8%-87.7%) than for those with cT1mi+1a tumors (0-1 cm; 96.8%; 95% CI, 94.2%-98.2%) and cT1b (1-2 cm; 95.3%; 95% CI, 92.1%-97.2%) (both P <.001), although that for cT1b tumors was comparably favorable to those of T1mi+1a tumors. Multivariable Cox regression analysis of recurrence-free survival revealed that a solid component size of 2 cm to 3 cm (cT1c) vs less than or equal to 2 cm (cT1mi+1a+1b) was an independent prognostic factor (hazard ratio, 4.16; 95% CI, 2.24-7.72; P <.001). The prognostic impact of a solid component size less than or equal to 2 cm and greater than 2 cm significantly differs after complete resection of GGO-mixed T1N0 lung adenocarcinoma. The prognosis of patients with solid components less than or equal to 2 cm is favorable, whereas the behavior of those solid components greater than 2 cm is more aggressive. [ABSTRACT FROM AUTHOR]

Interstitial pneumonia is linked to lung cancer, and treatment can cause acute exacerbation. We aimed to identify predictors of severe postoperative complications in patients with lung cancer and interstitial pneumonia. Between April 2007 and April 2017, 199 patients were diagnosed with primary lung cancer and interstitial pneumonia using high-resolution computed tomography. Multivariable logistic regression analyses were performed to identify independent predictors of severe complications (Clavien-Dindo grade IIIa or higher). Multivariable analyses revealed that severe complications were independently predicted by the percent diffusing capacity of the lungs for carbon monoxide (%D lco [odds ratio 0.88; 95% confidence interval, 0.82 to 0.95; P <.001]) and surgical procedures (lobectomy, odds ratio 4.49; 95% confidence interval, 1.86 to 23.32; P =.045). Severe complications occurred in 39.2% of patients with low %D lco (less than 40%) and in 4.2% of patients with high %D lco (greater than 40%). The rates of severe complications were 11.5% for patients who underwent lobectomy and 9.7% for patients who underwent sublobar resection. For patients with low %D lco , the rates of severe complications were 85.7% for those undergoing lobectomy and 23.8% for those undergoing sublobar resection (P =.009). Overall survival (OS) was significantly different between patients with low %D lco (5-year OS 33.5%) and patients with high %D lco (5-year OS 65.3%; P =.001). Among patients with low %D lco , there was a significant difference in OS between patients who underwent lobectomy (5-year OS 0%) and those who underwent sublobar resection (5-year OS 49.6%; P =.029). Severe postoperative complications were predicted by %D lco and surgery type. Sublobar resection might be a better option for patients with low %D lco values (less than 40%). [ABSTRACT FROM AUTHOR]

The aim of this study was to identify patients with pathological stage I lung adenocarcinoma at high risk of recurrence. We retrieved data from 536 patients with pathological stage I lung adenocarcinoma who underwent lobectomy and were enrolled in a prospective multiinstitutional study (the JCOG0201 study). Invasive component size, excluding lepidic component, was used as the tumor size. Recurrence-free survival (RFS) was estimated by the Kaplan-Meier method, and a multivariable Cox proportional hazards model identified independent prognostic factors associated with worse RFS. The all-patient 10-year RFS was 83.9% (median follow-up 10.2 years). Multivariable Cox analysis revealed that age greater than 65 years (hazard ratio [HR], 2.60; 95% confidence interval (CI), 1.66-4.07), invasive component size greater than 2 cm (HR, 2.70; 95% CI, 1.40-5.23), visceral pleural invasion (HR, 2.17; 95% CI, 1.23-3.81), and vascular invasion (HR, 2.59; 95% CI, 1.47-4.55) were potential independent prognostic factors for RFS. When patients were divided into a high-risk group for recurrence (invasive component size >2 cm or positive for visceral pleural invasion or for vascular invasion; n = 124) and a low-risk group (invasive component size ≤2 cm and negative for visceral pleural invasion and vascular invasion; n = 408), there was a significant difference in RFS between the high-risk and low-risk groups (high-risk group: HR, 3.61; 95% CI, 2.35-5.55). Pathological stage I lung adenocarcinoma patients with an invasive component size greater than 2 cm, visceral pleural invasion, or vascular invasion were at high risk for recurrence. [ABSTRACT FROM AUTHOR]

Background As segmentectomy becomes widely used for lung cancer treatment, complex segmentectomy, which makes several, intricate intersegmental planes, remains controversial because of procedural complexity and risk of increased complications and incurability. Questions remain about mortality, morbidity, surgical margin, lymph nodes dissection, and postoperative pulmonary function. We evaluated operative and postoperative outcomes of complex compared with simple segmentectomy. Methods We retrospectively reviewed patients with clinical stage I lung cancer who could tolerate lobectomy and underwent complex or simple segmentectomy between April 2007 and March 2017. Clinicopathologic, operative, and postoperative results of the complex (n = 117) and simple (n = 92) segmentectomy groups were compared. Results No statistically significant differences were detected in age, sex, comorbidities, preoperative pulmonary function, tumor histology, and size. Although only median operative time (180 versus 143.5 minutes, p < 0.0001) was significantly longer in the complex group, 30-day mortality (0% versus 0%), overall complications (24.8% versus 22.8%), and prolonged air leakage (11.9% versus 10.9%) were nearly equivalent between the two groups, respectively. The complex group showed comparable results in median surgical margin distance (16.0 versus 17.5 mm) and number of dissected lymph nodes (6.0 versus 7.0 nodes). Margin relapse occurred in 2 patients in the simple group but none occurred in the complex group. Both groups also showed similar postoperative pulmonary functions. Conclusions Complex segmentectomy is a safe option in the treatment of lung cancers with adequate operative outcomes. [ABSTRACT FROM AUTHOR]

Background The purpose of this study was to elucidate the clinical behavior of right middle lobe lung cancer, with focus on the tumor location. Methods We reviewed retrospectively 711 patients who underwent lobectomy or bilobectomy for clinical stage I non-small cell lung cancer (upper lobe, 346; middle lobe, 82; lower lobe, 283). Factors affecting survival were assessed by log rank tests and Cox regression analyses. Results The prognosis of patients with segment 5 tumors (n = 39) was significantly worse than that of patients with segment 4 tumors (n = 43; 5-year overall survival rates, 69.8% versus 87.6%, p = 0.040; and 5-year recurrence-free survival rates, 58.4% versus 73.0%, p = 0.029). Segment 5 tumors were an independent factor for poor prognosis in multivariable Cox regression analysis, and tended to cause more pathologic mediastinal lymph node metastases than segment 4 tumors (12.8% versus 2.3%, p = 0.097). Compared with tumors in the other lobes, patients with segment 4 tumors demonstrated no significant difference in prognosis; however, patients with segment 5 tumors demonstrated a significantly and outstandingly worse prognosis than patients with other lobe tumors (5-year overall survival rates, 69.8% versus 82.2%, p = 0.020; and 5-year recurrence-free survival rates, 58.4% versus 71.4%, p = 0.0071). Conclusions Patients with segment 5 tumors had a worse prognosis than patients with segment 4 and other lobe tumors. We speculate that is because segment 5 tumors cause more metastases to the mediastinal lymph nodes. Tumor location was an important prognostic factor for patients with right middle lobe lung cancer. [ABSTRACT FROM AUTHOR]

Background Despite its extensive size, variations in the clinicopathologic features of tumors in the lower lobe have been little studied. The present study investigated the prognostic differences in tumors originating from the superior and basal segments of the lower lobe in patients with non-small cell lung cancer. Methods Data of 134 patients who underwent lobectomy or segmentectomy with systematic nodal dissection for clinical stage I, radiologically solid-dominant, non-small cell lung cancer in the superior segment (n = 60) or basal segment (n = 74) between April 2007 and December 2015 were retrospectively reviewed. Factors affecting survival were assessed by the Kaplan-Meier method and Cox regression analyses. Results Prognosis in the superior segment group was worse than that in the basal segment group (5-year overall survival rates 62.6% versus 89.9%, p = 0.0072; and 5-year recurrence-free survival rates 54.4% versus 75.7%, p = 0.032). In multivariable Cox regression analysis, a superior segment tumor was an independent factor for poor overall survival (hazard ratio 3.33, 95% confidence interval: 1.22 to 13.5, p = 0.010) and recurrence-free survival (hazard ratio 2.90, 95% confidence interval: 1.20 to 7.00, p = 0.008). The superior segment group tended to have more pathologic mediastinal lymph node metastases than the basal segment group (15.0% versus 5.4%, p = 0.080). Conclusions Tumor location was a prognostic factor for clinical stage I non-small cell lung cancer in the lower lobe. Patients with superior segment tumors had worse prognosis than patients with basal segment tumors, with more metastases in mediastinal lymph nodes. [ABSTRACT FROM AUTHOR]

Background The prognosis of patients with small, node-negative lung cancers, which the current indication for adjuvant chemotherapy never includes, is sometimes poor despite complete tumor resection. The present study aimed to identify independent prognostic factors and to clarify possible candidates for adjuvant chemotherapy among patients with small, node-negative invasive adenocarcinoma. Methods This study involved 153 patients with completely resected small (≤20 mm) pathologic N0 invasive adenocarcinomas. Invasive adenocarcinoma was classified as lepidic predominant (LPA), papillary or acinar predominant (PA), or solid or micropapillary predominant (SM), according to the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society classification. Overall survival and recurrence-free survival were estimated from Kaplan-Meier curves. Prognostic factors for recurrence-free survival were determined using univariate and multivariate Cox proportional hazards models. Results Three-year overall survival and recurrence-free survival rates were 98% and 98%, 97% and 88%, and 85% and 64% for LPA, PA, and SM tumors, respectively. Prognosis was the worst for patients with SM tumors (overall survival LPA versus PA, p = 0.099; LPA versus SM, p < 0.001; and PA versus SM, p = 0.032; recurrence-free survival LPA versus PA, p = 0.014; LPA versus SM, p < 0.001; and PA versus SM, p < 0.001). Subtype was a significantly independent prognostic factor for recurrence-free survival in multivariate analysis (SM versus LPA hazard ratio 22, 95% confidence interval: 2.5 to 190, p = 0.0054). Conclusions Patients with small (≤20 mm) pathologic N0 solid or micropapillary predominant invasive adenocarcinoma might be possible candidates for adjuvant chemotherapy. [ABSTRACT FROM AUTHOR]

Pleurectomy/decortication is a surgical procedure for malignant pleural mesothelioma (MPM) and has been proposed as an alternative to extrapleural pneumonectomy. We report a second primary lung cancer developing after pleurectomy/decortication for MPM. A 59-year-old man was diagnosed with MPM on the right side and underwent pleurectomy/decortication. Follow-up computed tomography detected a nodule in the right upper lobe that was diagnosed as adenocarcinoma by wedge resection. Lung cancer and MPM are associated with asbestos exposure. However, predicting lung cancer after treatment for MPM is difficult. Careful follow-up of the spared lung is necessary for detecting second primary lung cancer or MPM recurrence. [ABSTRACT FROM AUTHOR]

Background: This study evaluated the usefulness of sublobar resection for patients with clinical stage IA lung adenocarcinoma that met our proposed node-negative criteria: solid tumor size of less than 0.8 cm on high-resolution computed tomography or maximum standardized uptake value of less than 1.5 on [18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography. Methods: A multicenter database of 618 patients with completely resected clinical stage IA lung adenocarcinoma who underwent preoperative high-resolution computed tomography and [18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography was used to evaluate the surgical results of sublobar resection for patients who met our node-negative criteria. Results: No patient who met the node-negative criteria had any pathological lymph node metastasis. Recurrence-free survival (RFS) and overall survival (OS) rates at 5 years were significantly higher for patients who met the node-negative criteria (RFS: 96.6%; OS: 95.9%) than for patients who did not (RFS: 75.5%, p < 0.0001; OS: 83.1%, p < 0.0001). Among patients who met the node-negative criteria, RFS and OS rates at 5 years were not significantly different between those who underwent lobectomy (RFS: 96.0%; OS: 95.9%) and those who underwent sublobar resection (RFS: 97.2%, p = 0.94; OS: 95.9%, p = 0.98). Of 264 patients with T1b (2-cm to 3-cm) tumors, 106 (40.2%) met the node-negative criteria. Conclusions: Sublobar resection without systematic nodal dissection is feasible for clinical stage IA lung adenocarcinoma that meets the above-mentioned node-negative criteria. Even a T1b tumor, which is generally unsuitable for intentional sublobar resection, can be a candidate for sublobar resection if it meets these node-negative criteria. [Copyright &y& Elsevier]

Background: This multicenter study aimed to validate the ability of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) plus high-resolution computed tomography (HR-CT) to predict the malignant behavior and prognosis of early adenocarcinomas of the lung. Methods: We calculated maximum standardized uptake values (maxSUV) from PET/CT images and ground-glass opacity (GGO) ratios on HR-CT images before complete surgical intervention in 610 patients with clinical stage IA lung adenocarcinoma. Pathologic invasiveness and survival were compared with clinical factors and radiographic findings including the maxSUV, which was revised to correct for interinstitutional discrepancies that confer limitations upon multicenter PET studies. Results: Analyses of receiver-operating characteristic curves revealed optimal maxSUV and GGO ratio cutoffs to predict recurrence of 2.9 and 25%, respectively. Both the maxSUV and GGO ratio reflected tumor invasiveness, nodal metastasis, recurrence, and patient survivals, and were significant prognostic factors for recurrence-free and cancer-specific survivals on multivariate Cox analysis (all, p < 0.001). The combination of maxSUV and GGO ratio is a better predictor of malignant tumor grade than either alone. Conclusions: The combination of maxSUV and GGO ratio as well as each alone are important predictors of prognosis in patients with clinical stage IA adenocarcinoma of the lung and should be considered before selecting therapeutic strategies. [Copyright &y& Elsevier]