Lobectomy Versus Sublobectomy in Stage IIIA/N2 Non-Small Cell Lung Cancer: A Population-Based Study

Abstract

BackgroundThe role lobectomy plays in stage IIIA/N2 non-small cell lung cancer (NSCLC) is controversial for a long time. What’s more, no previous study concentrates on whether sublobectomy can improve survival outcome for these patients, so we performed this population-based study to investigate whether stage IIIA/N2 NSCLC can benefit from these two surgery types and compare survival outcomes after lobectomy and sublobectomy.MethodsA total of 21,638 patients diagnosed with stage IIIA/N2 NSCLC between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database matched our selection criteria. The study cohort included patients who received no surgery (n = 15,951), sublobectomy (n = 628) and lobectomy (n = 5,059). Kaplan–Meier method, Cox regression analyses, and inverse probability of treatment weighting (IPTW)-adjusted Cox regression were used to illustrate the influence of sublobectomy and lobectomy on overall survival (OS) rates in the study cohort and compare these two surgery types.ResultsMultivariable Cox regression analysis showed sublobectomy [HR: 0.584 (95%CI: 0.531–0.644), P-value <0.001; IPTW-adjusted HR: 0.619 (95%CI: 0.605–0.633), P-value <0.001] and lobectomy [HR: 0.439 (95%CI: 0.420–0.459), P-value <0.001; IPTW-adjusted HR: 0.441 (95%CI: 0.431–0.451), P-value <0.001] were both related to better OS rates compared with no surgery, and lobectomy exhibited better survival than sublobectomy [HR: 0.751 (95%CI: 0.680–0.830), P-value <0.001; IPTW-adjusted HR: 0.713 (95%CI: 0.696–0.731), P-value <0.001]. Moreover, the results in subgroup analyses based on age, tumor size and radiotherapy and chemotherapy strategy in all study cohort were consistent.ConclusionStage IIIA/N2 NSCLC patients could benefit from sublobectomy or lobectomy, and lobectomy provided better OS rates than sublobectomy.

The prognosis of clinical stage IIIa non‐small cell lung cancer in Taiwan

“…Lobectomy provided significantly better OS than sublobar resection for patients less than 65 years old, but no difference was noted in patients over 65 years old. 18 It is interesting that segmentectomy was observed to result in significantly better OS than other surgical strategies in this study. No study compared the outcomes of lobectomy and segmentectomy in stage IIIa NSCLC patients.…”

“…Only one cohort study with 21,638 stage IIIa/N2 NSCLC patients from the Surveillance, Epidemiology, and End Results (SEER) database compared no surgery, sublobar resection, and lobectomy. Lobectomy provided significantly better OS than sublobar resection for patients less than 65 years old, but no difference was noted in patients over 65 years old 18 …”

“…Lobectomy provided significantly better OS than sublobar resection for patients less than 65 years old, but no difference was noted in patients over 65 years old. 18 …”

Role of Pneumonectomy in T1–4N2M0 Non-Small Cell Lung Cancer: A Propensity Score Matching Analysis

“…Utilizing the X-tile software from , continuous variables, including age and regional nodes examined/positive, were trichotomized to achieve the largest difference in OS between subgroups ( 10 , 11 ). We divided the enrolled patients into two groups, namely, patients receiving pneumonectomy and no surgery.…”

“…All baseline characteristics were included in the PSM logistic model except for regional nodes examined, and regional nodes positive for these two variables were highly determined by whether surgery was performed. These two variables were analyzed in the surgery group alone to determine their influence on OS and CSS ( 11 ). The OS and CSS of the two groups were compared before and after PSM with a Kaplan–Meier survival curve and the log-rank test.…”