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. 2024 Sep 30;13(9):2411-2423.
doi: 10.21037/tlcr-24-700. Epub 2024 Sep 27.

Effect of laterality on the postoperative survival of non-small cell lung cancer patients undergoing pneumonectomy

Zi-Ming Wang #  1 , Liang Guo #  1 , Yang Yang #  2 , Bo Tao  1 , Wen-Qiang Zhang  3 , Diego Gonzalez-Rivas  1   3   4 , Jens-C Rueckert  5 , Chee Yik Er  6 , Calvin S H Ng  7 , Moshe Lapidot  8   9 , Gaetano Rocco  10 , Mahmoud Ismail  3 , Chen-Lu Yang  1 , De-Ping Zhao  1
Affiliations

Effect of laterality on the postoperative survival of non-small cell lung cancer patients undergoing pneumonectomy

Zi-Ming Wang et al. Transl Lung Cancer Res. .

Abstract

Background: Pneumonectomy is one of the important surgical methods for non-small cell lung cancer (NSCLC). This study evaluated the effects of laterality on the short- and long-term survival of NSCLC patients undergoing pneumonectomy.

Methods: We reviewed the Surveillance, Epidemiology, and End Results database to retrieve the data of patients who underwent pneumonectomy for stage I-III NSCLC from 2004 to 2015. Propensity score matching (PSM) was used to reduce the selection bias. Logistic regression was used to analyze the correlation between laterality and mortality at 3, 6, and 9 months. The Kaplan-Meier curve was used to further assess the effect of laterality on overall survival (OS).

Results: A total of 4,763 patients met the enrollment criteria [right-sided, 1,988 (41.7%); left-sided, 2,775 (58.3%)]. After PSM, 1,911 patients for each side were included in the further analysis. The first 6 months following pneumonectomy was the main period of death, with 32.0% (428/1,336) and 19.9% (250/1,258) of right- and left-sided deaths occurring during this period. The logistic regression analysis showed that right-sided pneumonectomy was an independent risk factor for 3- (P<0.001) and 6-month (P<0.001) mortality. However, laterality had no significant effect on postoperative death at 7-9 months (P=0.82). In the total cohort, right-sided patients had worse OS (P<0.001), but the subgroup survival analysis of patients with a follow-up period >6 months revealed that laterality had no statistically significant effect on OS (P=0.75).

Conclusions: Right-sided pneumonectomy was associated with a higher perioperative mortality risk that lasted about 6 months. After that period, laterality was not observed to have a significant prognostic effect on the OS of patients undergoing pneumonectomy.

Keywords: Non-small cell lung cancer (NSCLC); laterality; pneumonectomy; survival.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-24-700/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Schematic of patient screening process. NSCLC, non-small cell lung cancer; AJCC, American Joint Committee on Cancer.
Figure 2
Figure 2
Postoperative mortality of enrolled patients after pneumonectomy. (A) Overall proportion of postoperative death in enrolled patients after pneumonectomy on each side. (B) Comparison of the mortality rates for left- and right-sided patients at different times within 12 months after pneumonectomy by the Chi-squared test.
Figure 3
Figure 3
The overall survival Kaplan-Meier curves of the enrolled patients who underwent a pneumonectomy in the total cohort (A) and the subgroup of patients with a follow-up time of more than 6 months (B).
See this image and copyright information in PMC

Comment in

  • Pneumonectomy-a necessary evil?
    Verkoulen KCHA, Geenen L, Franssen AJPM, van Roozendaal LM, Daemen JHT, Hulsewé KWE, Vissers YLJ, Gonzalez M, Guerrera F, de Loos ER. Verkoulen KCHA, et al. Transl Lung Cancer Res. 2025 May 30;14(5):1496-1499. doi: 10.21037/tlcr-2025-233. Epub 2025 May 20. Transl Lung Cancer Res. 2025. PMID: 40535075 Free PMC article. No abstract available.

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