Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2024 Jan;167(1):338-347.e1.
doi: 10.1016/j.jtcvs.2023.07.008. Epub 2023 Jul 18.

Lobectomy, segmentectomy, or wedge resection for peripheral clinical T1aN0 non-small cell lung cancer: A post hoc analysis of CALGB 140503 (Alliance)

Nasser Altorki  1 , Xiaofei Wang  2 , Bryce Damman  3 , Jennifer Mentlick  3 , Rodney Landreneau  4 , Dennis Wigle  5 , David R Jones  6 , Massimo Conti  7 , Ahmad S Ashrafi  8 , Moishe Liberman  9 , Marc de Perrot  10 , John D Mitchell  11 , Robert Keenan  12 , Thomas Bauer  13 , Daniel Miller  14 , Thomas E Stinchcombe  15
Affiliations
Randomized Controlled Trial

Lobectomy, segmentectomy, or wedge resection for peripheral clinical T1aN0 non-small cell lung cancer: A post hoc analysis of CALGB 140503 (Alliance)

Nasser Altorki et al. J Thorac Cardiovasc Surg. 2024 Jan.

Erratum in

Abstract

Background: We have recently reported the primary results of CALGB 140503 (Alliance), a randomized trial in patients with peripheral cT1aN0 non-small cell lung cancer (American Joint Committee on Cancer seventh) treated with either lobar resection (LR) or sublobar resection (SLR). Here we report differences in disease-free survival (DFS), overall survival (OS) and lung cancer-specific survival (LCSS) between LR, segmental resection (SR), and wedge resection (WR). We also report differences between WR and SR in terms of surgical margins, rate of locoregional recurrence (LRR), and expiratory flow rate at 6 months postoperatively.

Methods: Between June 2007 and March 2017, a total of 697 patients were randomized to LR (n = 357) or SLR (n = 340) stratified by clinical tumor size, histology, and smoking history. Ten patients were converted from SLR to LR, and 5 patients were converted from LR to SLR. Survival endpoints were estimated using the Kaplan-Maier estimator and tested by the stratified log-rank test. The Kruskal-Wallis test was used to compare margins and changes in forced expiratory volume in 1 second (FEV1) between groups, and the χ2 test was used to test the associations between recurrence and groups.

Results: A total of 362 patients had LR, 131 had SR, and 204 had WR. Basic demographic and clinical and pathologic characteristics were similar in the 3 groups. Five-year DFS was 64.7% after LR (95% confidence interval [CI], 59.6%-70.1%), 63.8% after SR (95% CI, 55.6%-73.2%), and 62.5% after WR (95% CI, 55.8%-69.9%) (P = .888, log-rank test). Five-year OS was 78.7% after LR, 81.9% after SR, and 79.7% after WR (P = .873, log-rank test). Five-year LCSS was 86.8% after LR, 89.2% after SR, and 89.7% after WR (P = .903, log-rank test). LRR occurred in 12% after SR and in 14% after WR (P = .295). At 6 months postoperatively, the median reduction in % FEV1 was 5% after WR and 3% after SR (P = .930).

Conclusions: In this large randomized trial, LR, SR, and WR were associated with similar survival outcomes. Although LRR was numerically higher after WR compared to SR, the difference was not statistically significant. There was no significant difference in the reduction of FEV1 between the SR and WR groups.

Keywords: lung cancer; randomized trial; sublobar resection.

PubMed Disclaimer

Figures

Figure 1:
Figure 1:
Disease-free survival (A); Overall survival (B); Lung Cancer Specific Survival (C)
Figure 2:
Figure 2:
Cumulative incidence of lung cancer and competing causes of deaths between SR and WR.
Figure 3:
Figure 3:
Locoregional recurrence-free survival for WR and SR
Figure 4:
Figure 4:
Graphical abstract
See this image and copyright information in PMC

Comment in

References

    1. Ginsberg RJ, Rubinstein LV; Lung Cancer Study Group. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Ann Thorac Surg 1995; 60: 615–23. - PubMed
    1. Saji H, Okada M, Tsuboi M, Nakajima R, Suzuki K, Aokage K, Aoki T, Okami J, Yoshino I, Ito H, Okumura N, Yamaguchi M, Ikeda N, Wakabayashi M, Nakamura K, Fukuda H, Nakamura S, Mitsudomi T, Watanabe SI, Asamura H; West Japan Oncology Group and Japan Clinical Oncology Group. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet. 2022. Apr 23;399(10335):1607–1617 - PubMed
    1. Altorki N, Wang X, Kozono D, Watt C, Landrenau R, Wigle D, Port J, Jones DR, Conti M, Ashrafi AS, Liberman M, Yasufuku K, Yang S, Mitchell JD, Pass H, Keenan R, Bauer T, Miller D, Kohman LJ, Stinchcombe TE, Vokes E. Lobar or Sublobar Resection for Peripheral Stage IA Non-Small-Cell Lung Cancer. N Engl J Med. 2023. Feb 9;388(6):489–498. - PMC - PubMed
    1. Mery CM, Pappas AN, Burt BM, Bueno R, Linden PA, Sugarbaker DJ, Jaklitsch MT. Diameter of non-small cell lung cancer correlates with long-term survival: implications for T stage. Chest. 2005. Nov;128(5):3255–60 - PubMed
    1. Speicher PJ, Gu L, Gulack BC, Wang X, D’Amico TA, Hartwig MG, Berry MF. Sublobar Resection for Clinical Stage IA Non-small-cell Lung Cancer in the United States. Clin Lung Cancer. 2016. Jan;17(1):47–55 - PMC - PubMed

Publication types