Comparative oncological features of centrally and peripherally located small-sized radiologically solid-dominant non-small-cell lung cancer

Abstract OBJECTIVES This study aimed to compare the oncological features of centrally and peripherally located small-sized (≤2 cm), radiologically solid-dominant, cN0 non-small-cell lung cancer (NSCLC). METHODS We retrospectively reviewed 1240 patients who underwent lobectomy or segmentectomy for radiologically solid-dominant cN0 NSCLC tumours ≤2 cm in size. Tumours were categorized as centrally (inner two-thirds of the pulmonary parenchyma) or peripherally (outer one-third) located. Clinicopathological characteristics and prognoses were compared between the 2 groups. RESULTS Among the 1240 patients, 299 had centrally located and 941 had peripherally located tumours. Centrally located tumours showed a significantly higher proportion of pure solid tumours and pathological lymph node upstaging than peripherally located tumours (P = 0.018 and P = 0.038, respectively). Multivariable logistic regression analysis identified central location as an independent predictor for pN1 (odds ratio, 1.91; 95% confidence interval, 1.09–3.36; P = 0.024), but not for pN2, upstaging. The cumulative incidence of loco-regional and distant recurrences did not significantly differ between the 2 groups (P = 0.455 and P = 0.383, respectively). Overall survival and recurrence-free survival rates were also similar among patients with central and peripheral tumours (P = 0.267 and P = 0.269, respectively). CONCLUSIONS Patient prognosis following complete anatomical resection was comparable between centrally and peripherally located radiologically solid-dominant cN0 NSCLC tumours ≤2 cm in size. However, centrally located tumours were associated with a higher risk of pN1 upstaging, highlighting the importance of thorough hilar lymph node dissection in these patients.