Comparative Effectiveness of Lobectomy, Segmentectomy, and Wedge Resection for Pathological Stage I Non-small Cell Lung Cancer in Elderly Patients: A Population-Based Study

Abstract

Introduction: This study was designed to assess the long-term survival of lobectomy, segmentectomy, and wedge resection for pathological stage I non-small cell lung cancer (NSCLC) in patients over 75 years of age. Patients and methods: Pathological stage I NSCLC patients aged ≥75 years who underwent lobectomy, segmentectomy, or wedge resection were identified from the Surveillance, Epidemiology, and End Results database. Propensity score-matched and competing risks analyses were conducted. The overall survival (OS) rate and lung cancer-specific survival (LCSS) rate were compared among the three groups based on the pathological stage. Results: A total of 3,345 patients were included. In the full cohort, the OS rate and LCSS rate of lobectomy were superior to wedge resection, but not to segmentectomy, the OS advantage diminished when patients were over 85 years old or when at least one lymph node was examined during the procedure. Stratified analyses showed that there was no significant difference in OS and LCSS rates among the three surgical procedures for patients with tumors smaller than 1.0 cm. The OS and LCSS of wedge resection, not segmentectomy, were inferior to lobectomy in stage IA2-IB tumors. Conclusion: Lobectomy should be recognized as the "gold standard" procedure for pathological stage I NSCLC in patients over 75 years of age, and segmentectomy could be considered as an effective alternative. Wedge resection could be considered for patients with compromised cardiopulmonary function or tumors smaller than 1.0 cm, and intraoperative lymph node examination should be conducted.

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

Figure 1

OS and LCSS of the full cohort and PS-matched cohort. (A) OS of the full cohort. (B) LCSS of the full cohort. (C) OS of the PS-matched cohort. (D) LCSS of the PS-matched cohort. OS, overall survival; LCSS, lung cancer–specific survival; PS, propensity score; WR, wedge resection; SE, segmentectomy; LO, lobectomy.

Figure 2

CIF of the full cohort and PS matched cohort. (A) CIF of the full cohort. (B) CIF of the PS-matched cohort. The area below the non-cancer–related death incidence function was defined as the cumulative incidence of non-cancer–related death, the area between the non-cancer–related death incidence function, and the all-cause death incidence function was defined as the cumulative incidence of lung cancer–related death, and the area above the all-cause death incidence function was defined as the cumulative incidence of being event free. CIF, cumulative incidence function; NCD, non-cancer–related death; ACD, all-cause death; PS, propensity score; WR, wedge resection; SE, segmentectomy; LO, lobectomy.

Figure 3

OS of patients in two age groups. (A) OS of patients between 75 and 85 years old. (B) OS of patients older than 85 years. OS, overall survival; SLR, sublobar resection; LO, lobectomy.

Figure 4

OS and LCSS of PS-matched patients with NSCLC in four TNM stages. (A) OS of patients with stage IA1 NSCLC. (B) LCSS of patients with stage IA1 NSCLC. (C) OS of patients with stage IA2 NSCLC. (D) LCSS of patients with stage IA2 NSCLC. (E) OS of patients with stage IA3 NSCLC. (F) LCSS of patients with stage IA3 NSCLC. (G) OS of patients with stage IB NSCLC. (H) LCSS of patients with stage IB NSCLC. OS, overall survival; LCSS, lung cancer–specific survival; PS, propensity score; WR, wedge resection; SE, segmentectomy; LO, lobectomy.

Figure 5

OS and LCSS of PS-matched patients with at least one lymph node detected during the procedure. (A) OS of PS-matched patients with at least one lymph node detected during the procedure. (B) LCSS of PS-matched patients with at least one lymph node detected during the procedure. OS, overall survival; LCSS, lung cancer–specific survival; PS, propensity score; WR, wedge resection; SE, segmentectomy; LO, lobectomy.

Figure 6

OS and LCSS of PS-matched patients who underwent either wedge resection or segmentectomy. (A) OS of PS-matched patients who underwent either wedge resection or segmentectomy. (B) LCSS of PS-matched patients who underwent either wedge resection or segmentectomy. PS, propensity score; WR, wedge resection; SE, segmentectomy; LO, lobectomy.