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. 2021 Jan;159(1):390-400.
doi: 10.1016/j.chest.2020.06.066. Epub 2020 Jul 8.

The Effect of Tumor Size and Histologic Findings on Outcomes After Segmentectomy vs Lobectomy for Clinically Node-Negative Non-Small Cell Lung Cancer

Vignesh Raman  1 , Oliver K Jawitz  2 , Soraya L Voigt  2 , Kristen E Rhodin  2 , Thomas A D'Amico  2 , David H Harpole  2 , Chi-Fu Jeffrey Yang  3 , Betty C Tong  2
Affiliations

The Effect of Tumor Size and Histologic Findings on Outcomes After Segmentectomy vs Lobectomy for Clinically Node-Negative Non-Small Cell Lung Cancer

Vignesh Raman et al. Chest. 2021 Jan.

Abstract

Background: The interaction between tumor size and the comparative prognosis of lobar and sublobar resection has been defined poorly.

Research question: The purpose of this study was to characterize the relationship between tumor size and the receipt of segmentectomy or lobectomy in association with overall survival in patients with clinically node-negative non-small cell lung cancer (NSCLC).

Study design and methods: The 2004-2015 National Cancer Database (NCDB) was queried for patients with cT1-3N0M0 NSCLC who underwent segmentectomy or lobectomy without neoadjuvant therapy or missing survival data. The primary outcome was overall survival, which was evaluated using multivariate Cox proportional hazards including an interaction term between tumor size and type of surgery.

Results: A total of 143,040 patients were included: 135,446 (95%) underwent lobectomy and 7594 (5%) underwent segmentectomy. In multivariate Cox regression, a significant three-way interaction was found among tumor size, histologic results, and type of surgery (P < .001). When patients were stratified by histologic results, lobectomy was associated with significantly improved survival compared with segmentectomy beyond a tumor size of approximately 10 mm for adenocarcinoma and 15 mm for squamous cell carcinoma that was recapitulated in subgroup analyses. No interaction between tumor size and type of surgery was found for patients with neuroendocrine tumors.

Interpretation: In this NCDB study of patients with node-negative NSCLC, we found different tumor size thresholds, based on histologic results, that identified populations of patients who least and most benefitted from lobectomy compared with segmentectomy.

Keywords: lobectomy; non-small cell lung cancer; sublobar resection; surgery.

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Figures

Figure 1
Figure 1
Graph showing the interaction between tumor size and type of surgery as a function of adjusted hazard ratio of mortality from a multivariate Cox proportional hazards model including an interaction term among tumor size, histologic results, and type of surgery. The overall cohort, regardless of histologic findings, is modelled in this plot. The x-axis shows the tumor size in millimeters, whereas the y-axis demonstrates the adjusted hazard ratio from the Cox model. The survival curves for patients who underwent lobectomy or segmentectomy are depicted and modelled using restricted cubic splines. The shaded areas represent the bounds of the 95% CI.
Figure 2
Figure 2
A, B, Graphs showing the interaction between tumor size and type of surgery as a function of adjusted hazard ratio of mortality from a multivariate Cox proportional hazards model including an interaction term between tumor size and type of surgery. These graphs show the overall group of patients with adenocarcinoma (A) and the subgroup with pathologic N0 disease as well (B). The x-axis shows the tumor size in millimeters, whereas the y-axis demonstrates the adjusted hazard ratio from the Cox model. The survival curves for patients who underwent lobectomy or segmentectomy are depicted and modelled using restricted cubic splines. The shaded areas represent the bounds of the 95% CI.
Figure 3
Figure 3
A, B, Graphs showing the interaction between tumor size and type of surgery as a function of adjusted hazard ratio of mortality from a multivariate Cox proportional hazards model including an interaction term between tumor size and type of surgery. These graphs show the overall group of patients with squamous cell carcinoma (A) and the subgroup with pathologic N0 disease as well (B). The x-axis shows the tumor size in millimeters, whereas the y-axis demonstrates the adjusted hazard ratio from the Cox model. The survival curves for patients who underwent lobectomy or segmentectomy are depicted and modelled using restricted cubic splines. The shaded areas represent the bounds of the 95% CI.
Figure 4
Figure 4
A, B, Graphs showing the interaction between tumor size and type of surgery as a function of adjusted hazard ratio of mortality from a multivariate Cox proportional hazards model including an interaction term between tumor size and type of surgery. These graphs show the overall group of patients with large cell lung cancer (A) and those with carcinoid histologic findings (B). The x-axis shows the tumor size in millimeters, whereas the y-axis demonstrates the adjusted hazard ratio from the Cox model. The survival curves for patients who underwent lobectomy or segmentectomy are depicted and modelled using restricted cubic splines. The shaded areas represent the bounds of the 95% CI.
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