Limited Resection Versus Lobectomy for Older Patients With Early-Stage Lung Cancer: Impact of Histology

Veluswamy, Rajwanth; Ezer, Nicole; Mhango, Grace; Goodman, Elliot R.; Bonomi, Marcelo; Neugut, Alfred I.; Swanson, Scott J.; Powell, Charles A.; Beasley, Mary Beth; Wisnivesky, Juan P.

doi:10.1200/jco.2014.60.6624

Cited by 100 publications

(70 citation statements)

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“…Limited resection is not adequate for patients with lymph node involvement. Similar to our results, Veluswamy and colleagues (27) identified stage IA invasive adenocarcinoma and squamous cell carcinoma with tumor size ≤2 cm among patients older than 65 years. They indicated that limited resection, particularly wedge resection, did not lead to equivalent outcomes as lobectomy.…”

Section: Discussionsupporting

confidence: 81%

Prognosis of limited resection versus lobectomy in elderly patients with invasive lung adenocarcinoma with tumor size less than or equal to 2 cm

et al. 2018

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Background: This study aimed to evaluate the prognostic difference between limited resection and lobectomy among elderly patients with small size lung adenocarcinoma. Methods: A total of 666 patients >65 years old with stage I lung adenocarcinoma and tumor size ≤2 cm were included. The patient survival was evaluated by disease-free survival (DFS) and overall survival (OS). Results: No DFS or OS advantage was found between the lobectomy and wedge resection groups when tumor sizes were ≤1 cm (DFS, P=0.112; OS, P=0.294). The wedge resection group had a significantly worse OS (P=0.041) than that in the lobectomy group when tumor sizes were >1 cm and ≤2 cm. Conclusions: We conclude that wedge resection may be a reasonable surgical choice for elderly patients with tumor sizes ≤1 cm. The International Association Study of Lung Cancer (IASLC), the American Thoracic Society (ATS) and the European Respiratory Society (ERS) proposed a new edition of the lung adenocarcinoma classification system in 2011 (12). It has been effectively used to predict the prognosis of lung adenocarcinoma patients. The classification was established on the most predominant subtype presented: invasive adenocarcinoma with solid (SOL) or micropapillary (MIP) carcinoma, which is associated with a poor survival (13)(14)(15)(16)(17). Both adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) have nearly 100% postsurgical survival, and limited resection is appropriate for those patients. However, to date, whether limited resection is adequate for early-stage invasive lung adenocarcinoma patients, especially for patients who are older than 65, has not been thoroughly studied (8). In this study, a large cohort investigation was carried out to determine the correlation between surgical procedures and postoperative survival among elderly lung adenocarcinoma patients with tumor sizes ≤2 cm. Our study may help to design personalized surgical strategies for older patients. Methods Patient cohortThe retrospective study was permitted by the Institutional Review Board of Shanghai Chest Hospital at Shanghai Jiao Tong University and was performed in compliance with the guidelines of clinical research [ethic approval ID: KS(P)1802].We retrospectively reviewed patients who underwent surgical resection at our hospital between January 2009 and March 2015. The inclusion criteria were patients 65 years old or older, presentation of a single lung nodule, the postsurgical pathological specimen examination validated that the tumor size was less than or equal to 2 cm, there was no lymph node invasion, and there was no distant organ metastasis. The exclusion criteria included patients who had a history of malignancy, had multiple nodules, received neoadjuvant chemotherapy AIS or MIA. Invasive adenocarcinoma variants (such as mucinous, enteric or fetal morphologies) were also excluded for low incidence. Finally, this study included a total of 666 patients.In our clinical practice, patients with the following characteristics were treated with limited resect...

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Section: Discussionsupporting

confidence: 81%

Prognosis of limited resection versus lobectomy in elderly patients with invasive lung adenocarcinoma with tumor size less than or equal to 2 cm

et al. 2018

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“…Our data also showed that these two surgical options might not result in similar survival rates in elderly patients (≥65 years old). This was in accord with Veluswamy's study, which also pointed out that differences might arise in elderly patients, depending on the different histology subgroups (29). In contrast, both segmentectomy and lobectomy could be optional for younger patients.…”

Section: Discussionsupporting

confidence: 77%

Long-term outcomes of stage I NSCLC (≤3 cm) patients following segmentectomy are equivalent to lobectomy under analogous extent of lymph node removal: a PSM based analysis

Qu¹,

Wang²,

Zhang³

et al. 2017

J. Thorac. Dis.

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Background: Segmentectomy has the advantage of less complications, but might have less lymph node sampling and higher risk of recurrence. We aimed to compare treatment outcome between two surgical options, and explore the effect of regional lymph node removal on the prognostic difference. Methods:We retrospectively analyzed data of stage I non-small cell lung cancer (NSCLC) (≤3 cm in size) patients who underwent either segmentectomy, or lobectomy, collected from the Surveillance, Epidemiology and End Results (SEER) database, from 2003 to 2013. The primary endpoints were overall survival (OS) and lung cancer-specific survival (LCSS). We also collected data from Shandong Provincial Hospital as validation.Results: Ultimately 1,156 patients treated by segmentectomy and 17,748 patients treated by lobectomy from SEER database were included in the analysis. Overall, segmentectomy was inferior to lobectomy in terms of OS [hazard ratio (HR): 1.316 (1.186-1.461), P<0.001] and LCSS [HR: 1.310 (1.142-1.504), P<0.001]. When the removal of regional lymph nodes (LN) was taken into consideration, no significant difference was found in OS and LCSS, in any Scope of Regional Lymph Node Surgery layer (0, 1-3, more than 3, and biopsy/sentinel layer, all P>0.05). After propensity score matching (PSM), there was no difference between segmentectomy and lobectomy in OS [HR: 1.081 (0.937-1.248), P=0.286] and LCSS [HR: 1.039 (0.861-1.253), P=0.692]. Only sex, age, histology, summary stage, differentiation, tumor size, and radiation still remained as independent prognostic factors for both OS and LCSS. For validation part, there was no significantly prognostic difference between lobectomy and sublobectomy group in overall (P=0.132) and each regional LN removed layer (0, 1-3, more than 3 layers: all P>0.05).Conclusions: Segmentectomy with proper lymph node resection or sampling could be a good alternative to lobectomy. IntroductionLung cancer is the leading cause of cancer-related death (26.5% of all) and has the second highest annual incidence in both males and females (13.3% for each), in the United States (1). More than half of lung cancer patients (57%) have distant metastasis at diagnosis, and overall 5-year relative survival rate is as low as 18% (1). Lung cancer can be divided into small cell lung cancer (SCLC, less than 20%) and non-small cell lung cancer (NSCLC, more than 80%), with entirely different treatment strategies and prognosis (2). Treatment strategies mainly include surgery, chemotherapy, radiotherapy, targeted therapy, and immunotherapy (2). Therein, approximately 69% of NSCLC patients with stages I and II are treated by surgery, compared to only 9% of patients with stages III and IV (2). Surgery is considered the best treatment option for early stage lung cancer, and anatomical lobectomy with N1 and at least three N2 stations sampling or dissection has become the standard surgery for early NSCLC patients (3). Minimally invasive video-assisted thoracoscopic lobectomy is also preferred for stage I NSCLC patients (4...

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“…Two other retrospective reviews comparing limited resection and lobectomy in stage I or II patients demonstrated a trend towards improved recurrence rate and OS in the lobectomy group that did not reach statistical significance (6,7). Other work has highlighted the potential importance of histology in tumors ≤2 cm, with lobectomy being associated with superior survival in squamous cell carcinoma compared to wedge resection or segmentectomy, and segmentectomy demonstrating equivalent survival to lobectomy in adenocarcinoma (8). Finally, a recent review of the National Cancer Database indicated that lobectomy was associated with improved OS, adequate lymphadenectomy rate, and negative margin rate (9).…”

mentioning

confidence: 99%

Limited resection versus lobectomy in early-stage non-small cell lung cancer

Toste¹,

Lee²

2016

J. Thorac. Dis.

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Limited Resection Versus Lobectomy for Older Patients With Early-Stage Lung Cancer: Impact of Histology

Abstract: We found generally that limited resection is not equivalent to lobectomy in older patients with invasive non-small-cell lung cancer ≤ 2 cm in size, although segmentectomy may be equivalent in patients with adenocarcinoma.

Cited by 100 publications

References 45 publications

Prognosis of limited resection versus lobectomy in elderly patients with invasive lung adenocarcinoma with tumor size less than or equal to 2 cm

Prognosis of limited resection versus lobectomy in elderly patients with invasive lung adenocarcinoma with tumor size less than or equal to 2 cm

Long-term outcomes of stage I NSCLC (≤3 cm) patients following segmentectomy are equivalent to lobectomy under analogous extent of lymph node removal: a PSM based analysis

Limited resection versus lobectomy in early-stage non-small cell lung cancer

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