"Lung Cancer Surgery, 'Personalized Treatment' Possible Based on Precision Medicine and Patient Characteristics"

Samsung Seoul Hospital Professors Kim Hong-gwan, Lee Jeong-hee, and Jo Ju-hee Team
Lymph Nodes, Minimal Resection for Early Patients
Extensive Resection Beneficial for Stage 3 Patients

Professor Hong-Kwan Kim (left), Professor Jung-Hee Lee, and Professor Joo-Hee Cho from the Clinical Epidemiology Research Center, Department of Thoracic and Esophageal Surgery, Samsung Medical Center.
[Photo by Samsung Medical Center]

[Asia Economy Reporter Lee Gwan-joo] It has been confirmed that lung cancer surgery can also be personalized based on precision medicine according to the characteristics of each patient.

The joint research team consisting of Professors Kim Hong-gwan and Lee Jeong-hee from the Department of Thoracic and Esophageal Surgery at Samsung Medical Center, Professor Jo Joo-hee from the Clinical Epidemiology Research Center, Ph.D. candidate Lee Jin from the Samsung Advanced Institute for Health Sciences & Technology, and Dr. Hong Yeon-soo from Johns Hopkins University announced on the 14th that by analyzing clinical information before surgery, the extent of lymph node dissection can be customized for each patient, which is also advantageous for improving survival rates. They published these results consecutively in two international academic journals.

First, in July, the research team reported in the official journal of the World Conference on Lung Cancer, the Journal of Thoracic Oncology, that patients who underwent minimal lymph node dissection had higher survival rates than those who underwent extensive lymph node dissection.

Until now, it has been common practice to remove not only the cancer but also the surrounding normal tissues and lymph nodes regardless of the cancer stage or degree of invasion. This extensive lymph node dissection was performed considering the nature of cancer, which may have micrometastases in the tumor visible to the naked eye as well as in the surrounding tissues and adjacent lymph nodes. The World Conference on Lung Cancer’s recommendations for complete resection also emphasize extensive dissection.

However, there have been concerns that applying extensive dissection uniformly to early-stage lung cancer detected through health checkups or lung cancers with ground-glass opacity, which have a good prognosis and a low possibility of peripheral micrometastasis, may impose unnecessary burdens on patients. Conversely, minimal dissection is a method that removes only what is necessary for lung cancers with no possibility of micrometastasis, preserving surrounding lymph nodes and tissues. This can reduce the surgical burden on patients and improve their quality of life after surgery.

Analyzing the 5-year postoperative survival rates of 5,117 patients with clinical stages 1 to 3 lung cancer who underwent surgery between 2008 and 2016, the research team found that among patients who underwent minimal dissection, those who preserved all surrounding lymph nodes had the highest survival rate at 90%. Those who removed some nodules and lymph nodes followed at 83%. Patients who underwent extensive dissection without preserving lymph nodes had the lowest survival rate at 80%. The 5-year progression-free survival rates showed a similar trend: minimal dissection patients who preserved lymph nodes had the highest rate at 86%, followed by partial dissection patients at 74%, and extensive dissection patients at 70%.

The research team explained, "Patients who underwent minimal dissection generally had lung cancers with low malignancy and no clear risk of metastasis. This means that for such patients, minimizing the surgical extent based on preoperative evaluation can reduce the risk of complications and improve survival rates."

On the other hand, in another study published in the Annals of Surgery, the research team found that extensive dissection improved survival rates for patients who required neoadjuvant chemotherapy. They compared postoperative survival rates of 910 patients diagnosed with stage 3 lung cancer with metastasis to mediastinal or subcarinal lymph nodes between 2003 and 2019. Unlike the previous case, these patients showed the highest 5-year survival rate of 60% in the extensive dissection group, followed by 52.9% in the minimal dissection group. The 5-year progression-free survival rates were also highest in the extensive dissection group (54.9%), followed by the minimal dissection group (46.2%). This suggests that for advanced lung cancer patients undergoing surgery after neoadjuvant chemoradiotherapy, extensive and complete resection is essential, unlike early-stage lung cancer with a good prognosis.

Professor Jo Joo-hee commented, "This study proves the implementation of precision medicine in surgery through big data analysis of lung cancer surgery," and evaluated, "The high-quality clinical records collected by establishing an internationally recognized lung cancer surgery registry from the early days of the hospital have become a valuable foundation for future patients to overcome cancer." Professor Kim Hong-gwan also said, "It reminded us once again of the simple truth that the answer is always with the patient," adding, "By accurately evaluating lung cancer surgery patients through data-driven precision medicine and tailoring surgery accordingly, we can help patients recover early and increase expectations for long-term survival."

This content was produced with the assistance of AI translation services.