Better Survival With Lobectomy Versus Sublobar Resection in Patients With Hypermetabolic C-Stage IA Lung Cancer on Positron Emission Tomography/Computed Tomography 

Recently, the CALGB 140503 trial and the JCOG0802/WJOG4607L showed the non-inferiority of sublobar resections compared to lobectomy for <2cm non-small cell lung cancer. The intensity of signal uptake on 18F-fluorodeoxyglucose positron emission tomography (PET) and computed tomography (CT) was reported to be a predictive marker of biologically aggressive behavior in lung cancers. The authors in this retrospective analysis reported the outcomes of sublobar compared to lobar resections for highly PET avid stage IA lung cancer (SUV>3). Both the five-year overall and disease-free survival rates were worse after sublobar resection compared with lobectomy (62.3 percent versus 79.9 percent and 53.9 percent versus 70.3 percent, respectively). Although there is inherent selection bias and confounding variables in this analysis, this article highlights the further research required to identify the interplay of different radiographic markers for predicting tumor aggression. This article also helps create guidelines regarding the choice of lung resection technique based on these markers.