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. 2016 Jan;17(1):47-55.
doi: 10.1016/j.cllc.2015.07.005. Epub 2015 Aug 3.

Sublobar Resection for Clinical Stage IA Non-small-cell Lung Cancer in the United States

Paul J Speicher  1 , Lin Gu  2 , Brian C Gulack  1 , Xiaofei Wang  2 , Thomas A D'Amico  1 , Matthew G Hartwig  1 , Mark F Berry  3
Affiliations

Sublobar Resection for Clinical Stage IA Non-small-cell Lung Cancer in the United States

Paul J Speicher et al. Clin Lung Cancer. 2016 Jan.

Abstract

Background: This study evaluated the use of lobectomy and sublobar resection for clinical stage IA non-small-cell lung cancer (NSCLC) in the National Cancer Data Base (NCDB).

Methods: The NCDB from 2003 to 2011 was analyzed to determine factors associated with the use of a sublobar resection versus a lobectomy for the treatment of clinical stage IA NSCLC. Overall survival was assessed using the Kaplan-Meier method and Cox proportional hazard modeling.

Results: Among 39,403 patients included for analysis, 29,736 (75.5%) received a lobectomy and 9667 (24.5%) received a sublobar resection: 84.7% wedge resection (n = 8192) and 15.3% segmental resection (n = 1475). Lymph node evaluation was not performed in 2788 (28.8%) of sublobar resection patients, and 7298 (75.5%) of sublobar resections were for tumors ≤ 2 cm. After multivariable logistic regression, older age, higher Charlson-Deyo comorbidity scores, smaller tumor size, and treatment at lower-volume institutions were associated with sublobar resection (all P < .001). Overall, lobectomy was associated with significantly improved 5-year survival compared to sublobar resection (66.2% vs. 51.2%; P < .001, adjusted hazard ratio 0.66; P < .001). However among sublobar resection patients, nodal sampling was associated with significantly better 5-year survival (58.2% vs. 46.4%; P < .001).

Conclusion: Despite adjustment for patient and tumor related characteristics, a sublobar resection is associated with significantly reduced long-term survival compared to a formal surgical lobectomy among patients with NSCLC, even for stage 1A tumors. For patients who cannot tolerate lobectomy and who are treated with sublobar resection, lymph node evaluation is essential to help guide further treatment.

Keywords: Lobectomy; Lung cancer; NSCLC; Stage IA; Sublobar resection.

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Conflict of interest statement

One of the authors (T.A.D.) serves as a consultant for Scanlan International, Inc.

Figures

Figure 1
Figure 1
Kaplan-Meier overall survival curve for lobectomy versus sublobar resection; stage IA NSCLC.
Figure 2
Figure 2
Kaplan-Meier survival curves demonstrating the association of lymph node sampling with outcomes among patients with stage IA NSCLC: (A) comparing patients treated with sublobar resection who underwent LN sampling versus those who did not; (B) comparing formal lobectomy versus sublobar resection that included LN sampling; and (C) for pathologic node-negative lobectomy versus pathologic node-negative sublobar resection.
See this image and copyright information in PMC

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