Comparison of Lobectomy and Sublobar Resection for Stage IA Elderly NSCLC Patients (≥70 Years): A Population-Based Propensity Score Matching’s Study

Zhang, Bo; Liu, Renwang; Li, Xiongfei; Wang, Yanye; Huo, Huandong; Zhu, Shuai; Song, Zuoqing; Xu, Song

doi:10.3389/fonc.2021.610638

Cited by 15 publications

(15 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These studies mostly involved open thoracotomy. The welldocumented (29) decrease in perioperative complications with VATS lobectomy in general is also noted in older patients: S3-2) (12,13,18,19,26,(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48). The hazard ratios (HRs) for OS and LCSS fairly consistently favor lobectomy.…”

Section: Mortality and Morbiditymentioning

confidence: 83%

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

View full text Add to dashboard Cite

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, ...

show abstract

Section: Mortality and Morbiditymentioning

confidence: 83%

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

View full text Add to dashboard Cite

show abstract

“…Lobectomy and sublobar resection (segmental resection and wedge resection) are the major surgical approaches for resectable lung tumours. Traditionally, lobectomy is accepted as the standard surgical procedure for early-stage non-small-cell lung cancer (NSCLC), while sublobar resection is regarded as an alternative for patients with limited pulmonary function [ 11 , 12 ]. However, due to relatively low rates of disease recurrence, metastasis and death, as well as the rarity of these tumours and the lack of prospective studies, no global consensus exists on the optimal extent of surgery for TC.…”

Section: Introductionmentioning

confidence: 99%

Sublobar resection versus lobectomy for patients with stage T1-2N0M0 pulmonary typical carcinoid tumours: a population-based propensity score matching analysis

Yang

Mei

2022

Interactive CardioVascular and Thoracic Surgery

View full text Add to dashboard Cite

Objectives It is widely accepted that surgical resection of localized pulmonary typical carcinoid (TC) tumours remains the primary curative modality. However, the optimal extent of resection remains controversial. This study aimed to investigate the survival rates of patients with stage T1-2N0M0 TC tumours who underwent sublobar resection or lobectomy. Methods We queried the Surveillance, Epidemiology, and End Results database for patients who underwent surgery after being diagnosed with stage T1-2N0M0 TCs from 2004 to 2016. Propensity score matching (PSM) analysis was used to equalize baseline characteristics between the sublobar resection group and the lobectomy group. Kaplan–Meier analysis and the Cox proportional hazard model were performed for survival analysis. Results Of the 2469 patients included, 658 (26.65%) underwent sublobar resection and 1811 (73.35%) underwent lobectomy. All 2469 patients were analysed with PSM and, following PSM, 812 patients were included in the final analysis, divided into two groups of 406 patients. In the matched cohort, Kaplan–Meier analysis demonstrated no significant difference in survival curves between the sublobar resection and lobectomy groups in patients with stage T1-2N0M0 TC tumours (5-year OS = 90.78% versus 93.30%; HR 1.18, 95% CI: 0.77–1.80; P = 0.505). Subgroup analysis by tumour size showed that the sublobar resection group was identical to the lobectomy group in overall survival (OS) for tumours ≤3.0 cm. In addition, no difference in OS between surgical groups was observed in any subgroups. In multivariable Cox analysis, age ≤ 65y, female sex, married status, and adequate lymph node assessment (≥5) were associated with improved OS, whereas the extent of resection was not. Conclusions Sublobar resection seems to be associated with similar survival to lobectomy for stage T1-2N0M0 TC tumours if lymph node assessment is performed adequately. This analysis suggests sublobar resection should be considered an appropriate alternative for stage T1-2N0M0 TC tumours. However, further validations are needed in large, multicentre prospective studies.

show abstract

“…Although we attempted to balance the baseline characteristics of the patients using the propensity score-matched method, there are some inevitable inherent biases. Secondly, in some cases, where a total lobectomy is not feasible, wedge resection or segmentectomy may be an effective treatment, especially for elderly patients, those with severe impairments in lung function, or others ( 12 – 14 ). However, the comorbidities and pulmonary function data were not included in the SEER database.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, lobectomy not only has lower regional and distant recurrence rates, but also has better survival outcomes compared with wedge resection or segmentectomy in stage I NSCLC ( 11 ). However, patients who cannot undergo lobectomy due to old age, poor lung function, or other preoperative comorbidities often need to undergo a limited resection instead ( 12 – 14 ). Currently, wedge resection (WR) and segmentectomy (SG) have become important treatment strategies for patients with stage IA NSCLCs ( 14 , 15 ).…”

Section: Introductionmentioning

confidence: 99%

Selection of the surgical approach for patients with cStage IA lung squamous cell carcinoma: A population-based propensity score matching analysis

et al. 2022

View full text Add to dashboard Cite

BackgroundThis study aimed to conduct a comparative analysis of the survival rates after segmentectomy, wedge resection, or lobectomy in patients with cStage IA lung squamous cell carcinoma (SCC).MethodsWe enrolled 4,316 patients who had cStage IA lung SCC from the Surveillance, Epidemiology, and End Results (SEER) database. The Cox proportional hazards model was conducted to recognize the potential risk factors for overall survival (OS) and lung cancer-specific survival (LCSS). To eliminate potential biases of included patients, the propensity score matching (PSM) method was used. OS and LCSS rates were compared among three groups stratified according to tumor size.ResultsKaplan–Meier analyses revealed no statistical differences in the rates of OS and LCSS between wedge resection (WR) and segmentectomy (SG) groups for patients who had cStage IA cancers. In patients with tumors ≤ 1 cm, LCSS favored lobectomy (Lob) compared to segmentectomy (SG), but a similar survival rate was obtained for wedge resection (WR) and lobectomy (Lob). For patients with tumors sized 1.1 to 2 cm, lobectomy had improved OS and LCSS rates compared to the segmentectomy or wedge resection groups, with the exception of a similar OS rate for lobectomy and segmentectomy. For tumors sized 2.1 to 3 cm, lobectomy had a higher rate of OS or LCSS than wedge resection or segmentectomy, except that lobectomy conferred a similar LCSS rate compared to segmentectomy. Multivariable analyses showed that patients aged ≥75 and tumor sizes of >2 to ≤3 cm were potential risk factors for OS and LCSS, while lobectomy and first malignant primary indicator were considered protective factors. The Cox proportional analysis also confirmed that male patients aged ≥65 to <75 were independent prognostic factors that are indicative of a worse OS rate.ConclusionsThe tumor size can influence the surgical procedure recommended for individuals with cStage IA lung SCC. For patients with tumors ≤1 cm, lobectomy is the recommended approach, and wedge resection or segmentectomy might be an alternative for those who cannot tolerate lobectomy if adequate surgical margin is achievable and enough nodes are sampled. For tumors >1 to ≤3 cm, lobectomy showed better survival outcomes than sublobar resection. Our findings require further validation by randomized controlled trial (RCT) or other evidence.

show abstract

Comparison of Lobectomy and Sublobar Resection for Stage IA Elderly NSCLC Patients (≥70 Years): A Population-Based Propensity Score Matching’s Study

Cited by 15 publications

References 36 publications

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

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

Sublobar resection versus lobectomy for patients with stage T1-2N0M0 pulmonary typical carcinoid tumours: a population-based propensity score matching analysis

Selection of the surgical approach for patients with cStage IA lung squamous cell carcinoma: A population-based propensity score matching analysis

Contact Info

Product

Resources

About