A propensity score matching analysis of survival following segmentectomy or wedge resection in early-stage lung invasive adenocarcinoma or squamous cell carcinoma

Zhang, Yang; Sun, Yihua; Chen, Haiquan

doi:10.18632/oncotarget.7284

Cited by 9 publications

(6 citation statements)

References 19 publications

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“…Two studies provided the data for patients in early stage NSCLC (tumor size ≤1 cm). As the study of Dai et al 24 used the same database as the research of Zhang et al, 23 Dai et al’s study could not be included. However, it provided the research about the tumor size ≤1 cm.…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis of segmentectomy versus wedge resection in stage IA non-small-cell lung cancer

Xue¹,

Duan²,

Zhang³

et al. 2018

OTT

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BackgroundAlthough limited resection was once considered the surgical treatment for patients with Phase IA non-small-cell lung cancer (NSCLC), there has been an ongoing controversial surgical indication for wedge resection and segmentectomy in recent years. The objective of this study was to compare overall survival (OS) and disease-free survival (DFS) of segmentectomy and wedge resection for early stage NSCLC, using a meta-analysis.MethodsSystematic research was conducted using four online databases to search for studies published before 2017. The DFS and OS for early stage NSCLC after segmentectomy and wedge resection were compared. The studies were selected according to rigorous predefined inclusion criteria, and meta-analyzed using the log (hazard ratio; ln[HR]) and its standard error (SE) calculations.ResultsIncluded in this meta-analysis were nine studies, published from 2006 to 2017, with a total of 7,272 patients. Survival outcome of segmentectomy was comparable to wedge resections for stage IA lung cancer because of OS (similar hazard ratio [HR]: 0.93, 95% confidence interval [CI]: 0.83–1.05, P=0.26) and DFS (similar HR: 0.81, 95% CI: 0.60–1.09, P=0.17). Nevertheless, for stage IA NSCLC with tumor size ≤2 cm, segmentectomy was superior to wedge resection (combined HR: 0.82, 95% CI: 0.70–0.97, P=0.02). However, there were no significant differences in OS rates, 1.07 (95% CI: 0.78–1.46, P=0.68), between segmentectomy and wedge resection for IA NSCLC with a tumor size of ≤1 cm.ConclusionThis study concluded that segmentectomy could achieve better OS than wedge resection for stage IA NSCLC with a tumor size of ≤2 cm. However, surgeons could conduct segmentectomy and wedge resection for NSCLC ≤1 cm according to patient profile and the location of tumor. These results should be confirmed by further randomized clinical trials.

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Section: Resultsmentioning

confidence: 99%

Meta-analysis of segmentectomy versus wedge resection in stage IA non-small-cell lung cancer

Xue¹,

Duan²,

Zhang³

et al. 2018

OTT

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“…Accumulated clinical evidence has demonstrated that sublobar resection may have an important role in stage IA NSCLC treatment. However, due to the lack of large cohort studies to determine prognostic factors affecting patients undergoing sublobar resection, the efficacy of sublobar resection has not been fully evaluated 5. Nomogram, which creates a plain visual representation of a statistical predictive model yielding a numerical probability of a clinical outcome, is widely used to predict prognosis in cancer patients 6.…”

Section: Introductionmentioning

confidence: 99%

A nomogram to predict prognosis in patients undergoing sublobar resection for stage IA non-small-cell lung cancer

Yang

Shi

et al. 2018

CMAR

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IntroductionThis study aimed to develop a practical nomogram to predict prognosis in patients who are undergoing sublobar resection for stage IA non-small-cell lung cancer (NSCLC). Data from Surveillance, Epidemiology, and End Results (SEER) databases were used to construct the nomogram.MethodsData from patients undergoing sublobar resection for stage IA NSCLC diagnosed between 2004 and 2014 were extracted from the SEER database. Factors that may predict the outcome were identified using the Kaplan–Meier method and the Cox proportional-hazards model. A nomogram was constructed to predict the 3- and 5-year overall survival (OS) and lung cancer-specific survival (LCSS) rates of these patients. The predictive accuracy of the nomogram was measured using the concordance index (C-index) and calibration curve.ResultsA total of 4,866 patients were selected for this study. Using univariate and multivariate analyses, eight independent prognostic factors associated with OS were identified, including sex (P<0.001), age (P<0.001), race (P=0.043), marital status (P=0.009), pathology (P=0.004), differentiation (P<0.001), tumor size (P<0.001), and surgery (P=0.001), and five independent prognostic factors associated with LCSS were also identified, including sex (P<0.001), age (P<0.001), differentiation (P<0.001), tumor size (P<0.001), and surgery (P=0.011). A nomogram was established based on these results and validated using the internal bootstrap resampling method. The C-index of the established nomogram for OS and LCSS was 0.649 (95% CI: 0.635–0.663) and 0.640 (95% CI: 0.622–0.658), respectively. The calibration curves for probability of 3-, and 5-year OS and LCSS rates demonstrated good agreement between the nomogram prediction and actual observation.ConclusionThis innovative nomogram delivered a relatively accurate individual prognostic prediction for patients undergoing sublobar resection for stage IA NSCLC.

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“…Unfortunately, current evidence is inadequate to determine the said hypothesized survival difference due to the absence of relevant randomized controlled trials (RCTs). Although a considerable amount of retrospective studies have suggested that segmentectomy is superior to wedge resection regarding longterm survival (39)(40)(41), there is evidence to the contrary that wedge resection is similar to segmentectomy (42,43). Our results suggested that segmentectomy is superior to wedge resection in terms of LCSS in patients over 75 years old, although it may not have an OS advantage over wedge resection.…”

Section: Discussionmentioning

confidence: 51%

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

Zhang

Lin

2021

Front. Surg.

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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.

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A propensity score matching analysis of survival following segmentectomy or wedge resection in early-stage lung invasive adenocarcinoma or squamous cell carcinoma

Cited by 9 publications

References 19 publications

Meta-analysis of segmentectomy versus wedge resection in stage IA non-small-cell lung cancer

Meta-analysis of segmentectomy versus wedge resection in stage IA non-small-cell lung cancer

A nomogram to predict prognosis in patients undergoing sublobar resection for stage IA non-small-cell lung cancer

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

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