Age-different extent of resection for clinical IA non-small cell lung cancer: analysis of nodal metastasis

Deng, Han‐Yu; Zhou, Jie; Wang, Ru-Lan; Jiang, Rui; Qiu, Xiaoming; Zhu, Daxing; Tang, Xiaojun; Zhou, Qinghua

doi:10.1038/s41598-020-66509-5

Cited by 6 publications

(6 citation statements)

References 29 publications

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“…The underlying mechanism that the effect of number of lymph nodes on long-term survival diminishes with age is currently unclear. Considering the equivalent NCSS between the two age groups, our study resonated with the results obtained by Han-Yu Deng et al (38) that age could be an independent predictor of lymph node metastasis, which indirectly affected the oncological effects of lymph node harvesting in elderly patients. This question is expected to be solved in more extensive and specific research in the future.…”

Section: Discussionsupporting

confidence: 88%

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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Section: Discussionsupporting

confidence: 88%

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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“…The superior outcome of the lobectomy cohort in the smaller tumor group could also be explained by a greater proportion of wedge resections being performed for those tumors <2 cm, and more segmentectomies for those tumors >2 cm resulting in oncologic outcomes approximating lobectomy. Furthermore, we could not conclude the favorable surgical approach in the elderly patients regarding long-term survival, which was in line with prior research (26), and might be attributed to a low malignant behavior of the tumor among the elderly compared with younger patients (27). Several studies claimed that the OS was not associated with the pathological stage in the elderly, and quite a few elderly patients might die of non-cancer-related causes, and thus, complete tumor resection was only a part in improving the prognosis (26,28).…”

Section: Discussionsupporting

confidence: 75%

“…Furthermore, we could not conclude the favorable surgical approach in the elderly patients regarding long-term survival, which was in line with prior research ( 26 ), and might be attributed to a low malignant behavior of the tumor among the elderly compared with younger patients ( 27 ). Several studies claimed that the OS was not associated with the pathological stage in the elderly, and quite a few elderly patients might die of non-cancer-related causes, and thus, complete tumor resection was only a part in improving the prognosis ( 26 , 28 ).…”

Section: Discussionsupporting

confidence: 72%

Treatment Modality for Stage IB Peripheral Non-Small Cell Lung Cancer With Visceral Pleural Invasion and ≤3 cm in Size

Huang¹,

Deng²,

Lin³

et al. 2022

Front. Oncol.

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PurposeTo compare the survival difference among lobectomy, segmentectomy, and wedge resection and investigate the role of adjuvant chemotherapy for early-stage small-sized non-small cell lung cancer (NSCLC) with visceral pleural invasion (VPI).MethodsPatients diagnosed with stage IB peripheral NSCLC with VPI and ≤3 cm in size in the Surveillance, Epidemiology, and End Results database between 2004 and 2015 were included, and the pleural layer (PL) invasion status was identified to recognize the tumors with VPI, including PL1 and PL2. We conducted Cox proportional hazards model in multivariable analysis and subgroup analysis via propensity score matching (PSM) method and Cox regression method to figure out the optimal therapy for these patients.ResultsA total of 1,993 patients were included, all of whom received surgery, and the median follow-up was 33 months (range, 1–83 months). In multivariable analysis, age, gender, histology, pathological grade, lymph node examination, surgical approaches, and radiotherapy were independent prognostic factors for overall survival (OS). Lobectomy was superior to sublobar resection [hazard ratio (HR) = 1.41; 95% CI, 1.08–1.83], and wedge resection was associated with impaired survival compared to lobectomy (HR = 1.64; 95% CI, 1.22–2.20) in PSM analyses. In subgroup analysis, lobectomy was superior to sublobar resection among those aged <70 years (HR = 1.81; 95% CI, 1.13–2.90), female (HR = 1.75; 95% CI, 1.21–2.53), and 1–20 mm in size (HR = 1.61; 95% CI, 1.11–2.33). No survival benefit was observed for adjuvant chemotherapy.ConclusionsLobectomy was superior to wedge resection and comparable with segmentectomy for stage IB NSCLC (≤3 cm) with VPI, and adjuvant chemotherapy could not benefit these patients, even in those with sublobar resection. The preferred surgical procedure remains to be studied in prospective controlled trials.

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“…A propensity-matched study suggested decreased aggressiveness of cIA NSCLC in older patients (>65)noting less N1 or N2 involvement despite the same extent of intraoperative node evaluation (69). However, the impact of worse differentiation and a greater consolidation/tumor ratio (CTR, solid/whole tumor size on lung windows) was far greater-i.e., it may be more important to focus on markers of tumor behavior than age.…”

Section: Sources Of Ambiguity and Nuances Of Applicabilitymentioning

confidence: 99%

A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation—part 3: systematic review of evidence regarding surgery in compromised patients or specific tumors

Bade¹,

Blasberg²,

Mase³

et al. 2022

J Thorac Dis

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Background: Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options [lobectomy, segmentectomy, wedge, stereotactic body radiotherapy (SBRT), thermal ablation], weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making.Methods: A PubMed systematic review from 2000-2021 of outcomes after lobectomy, segmentectomy and wedge resection in older patients, patients with limited pulmonary reserve and favorable tumors is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons (NRCs) with adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved.Results: In older patients, perioperative mortality is minimally altered by resection extent and only slightly affected by increasing age; sublobar resection may slightly decrease morbidity. Long-term outcomes are worse after lesser resection; the difference is slightly attenuated with increasing age. Reported short-term outcomes are quite acceptable in (selected) patients with severely limited pulmonary reserve, not clearly altered by resection extent but substantially improved by a minimally invasive approach. Quality-of-life (QOL) and impact on pulmonary function hasn't been well studied, but there appears to be little difference by resection extent in older or compromised patients. Patient selection is paramount but not well defined.Ground-glass and screen-detected tumors exhibit favorable long-term outcomes regardless of resection extent; however solid tumors <1 cm are not a reliably favorable group.Conclusions: A systematic, comprehensive summary of evidence regarding resection extent in compromised patients and favorable tumors with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation for a framework for individualized decision-making.Review Article on A Guide for Managing Patients with Stage I NSCLC: Deciding between Lobectomy, Segmentectomy, Wedge, SBRT and Ablation A detailed description of the approach is provided elsewhere (see Methods section of Part 1) (1). Briefly, the subject is stage cIA NSCLC (using the 8 th edition nomenclature t h r o u g h o u t ) . I n t e r v e n t i o n s i n c l u d e l o b e c t o m y, segmentectomy, wedge resection, SBRT and ablation. The most relevant outcomes were chosen a priori: short-term treatment-related mortality, toxicity/morbidity, ...

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Age-different extent of resection for clinical IA non-small cell lung cancer: analysis of nodal metastasis

Cited by 6 publications

References 29 publications

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

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

Treatment Modality for Stage IB Peripheral Non-Small Cell Lung Cancer With Visceral Pleural Invasion and ≤3 cm in Size

A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation—part 3: systematic review of evidence regarding surgery in compromised patients or specific tumors

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