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Comparative Study
. 2018 Aug;106(2):375-381.
doi: 10.1016/j.athoracsur.2018.02.049. Epub 2018 Mar 23.

Long-Term Results for Clinical Stage IA Lung Cancer: Comparing Lobectomy and Sublobar Resection

Melanie Subramanian  1 , Timothy McMurry  2 , Bryan F Meyers  1 , Varun Puri  1 , Benjamin D Kozower  3
Affiliations
Comparative Study

Long-Term Results for Clinical Stage IA Lung Cancer: Comparing Lobectomy and Sublobar Resection

Melanie Subramanian et al. Ann Thorac Surg. 2018 Aug.

Abstract

Background: Lobectomy has been compared with sublobar resection for the treatment of stage IA non-small cell lung cancer (NSCLC). Accurate long-term data are lacking on the risk of recurrence in routine clinical practice. This study used a unique and representative dataset to compare recurrence, overall survival (OS), and lymph node staging between lobectomy and sublobar resection.

Methods: The American College of Surgeons performed a Special Study of the National Cancer Data Base, by reabstracting records to augment NSCLC data with enhanced information on preoperative comorbidity and cancer recurrence from 2007 to 2012. For patients treated with lobectomy or sublobar resection (wedge resection or segmentectomy) for clinical stage IA NSCLC, propensity matching and competing risks models compared 5-year OS and risk of cancer recurrence. Secondary measures included lymph nodes collected, pathologic upstaging, and surgical margin status.

Results: A total of 1,687 patients with stage IA NSCLC were identified (1,354 who underwent lobectomy, and 333 who had sublobar resections). Propensity matching yielded 325 pairs. Lobectomy and sublobar resection groups had similar 5-year OS (61.8% vs 55.6%, p = 0.561). The sublobar group had a 39% increased risk of NSCLC recurrence (hazard ratio, 1.39; 95% confidence interval, 1.04 to 1.87). Median lymph node counts were higher for lobectomy-treated patients (7 [3, 10] vs 1 [0, 4], p < 0.001)].

Conclusions: In an enhanced national dataset representative of outcomes for stage IA NSCLC, sublobar resection was associated with a 39% increased risk of cancer recurrence. The majority of patients treated with sublobar resection had an inadequate lymph node assessment. These real-world results must be considered when existing clinical trial results comparing these treatments are extrapolated for clinical use.

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Figures

Figure 1.
Figure 1.
Kaplan-Meier curve for OS by extent of surgical resection, unmatched patients
Figure 2.
Figure 2.
Kaplan-Meier curve for OS by extent of surgical resection, propensity score matched patients
Figure 3.
Figure 3.
Risk of recurrence estimated for a 67 year old female patient with pathologic stage 1A NSCLC adenocarcinoma, by resection type
See this image and copyright information in PMC

Comment in

  • The problem with sublobar resections.
    Cao C, Tian DH, Fu B, Huang J, Ranganath NK, Gossot D. Cao C, et al. J Thorac Dis. 2018 Sep;10(Suppl 26):S3224-S3226. doi: 10.21037/jtd.2018.08.102. J Thorac Dis. 2018. PMID: 30370120 Free PMC article. No abstract available.
  • Failure to Harvest Lymph Nodes.
    Baciewicz FA Jr. Baciewicz FA Jr. Ann Thorac Surg. 2019 Apr;107(4):1287. doi: 10.1016/j.athoracsur.2018.09.027. Epub 2018 Oct 31. Ann Thorac Surg. 2019. PMID: 30391246 No abstract available.
  • Reply.
    Subramanian M, Kozower BD. Subramanian M, et al. Ann Thorac Surg. 2019 Apr;107(4):1287. doi: 10.1016/j.athoracsur.2018.11.026. Epub 2018 Dec 14. Ann Thorac Surg. 2019. PMID: 30557536 No abstract available.

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