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. 2019 Jul;20(4):e463-e469.
doi: 10.1016/j.cllc.2019.03.006. Epub 2019 Apr 1.

Node-Positive Segmentectomy for Non-Small-Cell Lung Cancer: Risk Factors and Outcomes

Waseem Lutfi  1 , Matthew J Schuchert  1 , Rajeev Dhupar  1 , Chigozirim Ekeke  1 , Inderpal S Sarkaria  1 , Neil A Christie  1 , James D Luketich  1 , Olugbenga T Okusanya  2
Affiliations

Node-Positive Segmentectomy for Non-Small-Cell Lung Cancer: Risk Factors and Outcomes

Waseem Lutfi et al. Clin Lung Cancer. 2019 Jul.

Abstract

Background: Segmentectomy for well-selected early stage non-small-cell lung carcinoma (NSCLC) has been shown to have similar oncologic outcomes and survival to lobectomy. However, these data are based on the presumption that the disease is node negative. Few data exist regarding the risk factors for and the outcomes of patients with disease treated with segmentectomy that is found to be node positive. We sought to determine the risk factors for and outcomes of clinical stage I NSCLC patients who are treated with segmentectomy but are determined to be node positive.

Patients and methods: We queried patients with clinical stage I NSCLC ≤ 3 cm within the National Cancer Data Base between 2004 and 2014 who were treated with segmentectomy or lobectomy and found to have positive nodes. Kaplan-Meier curves with log-rank tests were used to compare overall survival (OS) between segmentectomy and lobectomy. For comparison only, segmentectomy patients with pathologically node-negative disease were identified to determine predictors of node positivity after segmentectomy via multivariable logistic regression.

Results: A total of 4556 patients with node-positive disease were identified, comprising 115 segmentectomy patients and 4441 lobectomy patients. Multivariable analysis identified increasing tumor size, squamous-cell histology, and increasing number lymph nodes sampled as significant predictors of node positivity after segmentectomy. There was no difference in OS between segmentectomy and lobectomy, with 3-year OS rates of 66.3% and 68.1%, respectively (P = .723).

Conclusion: There are discrete risk factors for discovering positive nodes after segmentectomy. Segmentectomy is associated with similar OS compared to lobectomy for clinical stage I NSCLC found to be node positive.

Keywords: Early stage; Lymph nodes; National Cancer Data Base; Surgical resection; Survival.

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Conflict of interest statement

Disclosure

The authors have stated that they have no conflict of interest.

Figures

Figure 1
Figure 1
Inclusion Criteria
Figure 2
Figure 2
Kaplan-Meier Survival Curves for Segmentectomy Versus Lobectomy (P = .723)
Figure 3
Figure 3
Kaplan-Meier Survival Curves for Segmentectomy Versus Lobectomy in (A) pN1 Patients (P = .964) and (B) pN2 Patients (P = .449)
See this image and copyright information in PMC

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