Location of stage I–III non‐small cell lung cancer and survival rate: Systematic review and meta‐analysis

Lee, Hyun Woo; Lee, Chang Hoon; Park, Young Sik

doi:10.1111/1759-7714.12869

Cited by 43 publications

(41 citation statements)

References 37 publications

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“…To our surprise, we found that the primary site and surgery type could affect the prognosis. Similar results were also obtained in a published meta-analysis ( 26 ). In another study, the results showed no significant difference in OS between lesions located in the upper/middle and lower lobes ( 27 ).…”

Section: Discussionsupporting

confidence: 89%

Identification of Resectable N2 in NSCLC: A Single Center Experience and Review of the SEER Database

et al. 2021

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BackgroundNon-small cell lung carcinoma (NSCLC) with ipsilateral and/or subcarinal mediastinal lymphatic spread (N2) is a heterogeneous disease. The role of surgical resection in patients with N2 NSCLC remains controversial and no survival-based definition of “resectable N2” exists. The purpose of this study is to evaluate the factors that potentially affect the survival of N2 NSCLC patients who receive surgical resection and to define “resectable N2” based on the survival benefits.MethodsData from the open Surveillance, Epidemiology, and End Results (SEER) database from the National Cancer Institute in the United States were used to construct a nomogram. Patients who received surgery between 2010 and 2015 for N2 NSCLC were included. Independent prognostic factors for survival identified through Cox regression analysis were used to create the nomogram. The C-index, receiver operating characteristics (ROC) analyses, calibration curves, and risk stratification were used to evaluate the nomogram. The nomogram was also validated using data from 222 patients from Peking Union Medical College Hospital (PUMCH). Furthermore, lung cancer–related deaths were compared using competitive risk analysis.ResultsIn total, 4267 patients were included in the SEER cohort. Male gender, old age, high T stage and grade, adenosquamous and squamous cell carcinoma, lower lobe and overlapping lesions, extended lobe or bilobectomy and pneumonectomy, no chemotherapy, radiation before and after surgery, positive number of lymph nodes, and lymph node ratio (LNR) were identified as independent risk factors for higher mortality. The nomogram was created using these parameters. The C-index was 0.665 (95% confidence interval (CI), 0.651-0.679) and 0.722 (95% CI, 0.620-0.824) in the SEER and PUMCH cohorts, respectively. The calibration curves showed satisfactory consistency between the predicted and actual survival status in both the SEER and PUMCH cohorts. Competitive risk analysis confirmed that the variables in the nomogram, except radiation, are risk factors for prognosis.Conclusions“Resectable N2” should be assessed by a multidisciplinary team. The novel nomogram developed in this study may help with clinical decision-making for this patient population.

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Section: Discussionsupporting

confidence: 89%

Identification of Resectable N2 in NSCLC: A Single Center Experience and Review of the SEER Database

et al. 2021

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“…The primary site of tumour was an important predictor of overall survival in the patients without metastasis in our study. It supports the ndings of previous studies, which reported that upper lobe tumours were associated with better survival compared to those located in other sites of the lung 17,35 . Our study also revealed an association between tumours in the main bronchus and poorer overall survival compared to the upper lobe tumours.…”

Section: Discussionsupporting

confidence: 91%

Factors associated with overall survival in patients with non-squamous NSCLC in New Zealand: A comparative analysis by EGFR gene mutation status

Aye

McKeage

Tin

et al. 2020

Preprint

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Introduction: Non-small cell lung cancer (NSCLC) is increasingly regarded as a heterogeneous group of diseases defined by specific gene mutations. Previous studies reported inconsistent results regarding the influence of epidermal growth factor receptor (EGFR) mutations on overall survival. This study assesses the effect of EGFR mutation on overall survival, and how the effects of other survival predictors are modified by EGFR mutation status, in non-squamous NSCLC patients.Methods: The study was based on a population-based cohort of 1534 non-squamous NSCLC patients who were registered in northern New Zealand between 1 February 2010 and 31 July 2017. Kaplan-Meier analyses and log-rank tests were performed to assess the overall survival among different patient groups. Cox regression survival analyses were used to explore the associations between clinico-pathological factors and overall survival in terms of EGFR mutation status. The factors included were age at diagnosis, sex, ethnicity, smoking status, performance status, metastasis status and site of tumour. Results: In this cohort, 20.2% had an EGFR mutation. The median overall survival was 0.79 years and 2.81 years in EGFR mutation-negative and mutation-positive groups respectively (log-rank p<0.0001). Metastasis status showed large and significant effects on overall survival in both EGFR mutation-negative and mutation-positive groups (hazard ratio, HR=3.6 and 3.3, respectively). In subgroup analyses by mutation status and metastasis status, overall survival decreased with an increase in age and decrease in performance status, and was lower in current smokers in all subgroups. In specific groups, females had lower survival only if mutation-positive; Māori had lower survival compared to NZ Europeans only if the disease was metastatic; and tumour site had significant effects on overall survival only in patients without metastasis. Conclusion: EGFR mutation status and metastasis are the main predictors for overall survival in non-squamous NSCLC patients in northern New Zealand. The effects of age, smoking status and performance status are similar in all subgroups, but the effects of sex, ethnicity and site of tumour vary depending on EGFR mutation and metastasis status.

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“…Extent of lymph node dissection was not considered for either lobar or sublobar resection, and as mentioned previously, there was no consideration to lobe or segment in the analysis. Previous work has found that lower lobe origin of NSCLC confers worse mortality 19,20 . We found that there was no difference between lower lobectomy for superior segment tumors or superior segmentectomy for OS, DFS, LRFS.…”

Section: Discussionmentioning

confidence: 38%

Outcomes of superior segmentectomy versus lower lobectomy for superior segment Stage I non‐small‐cell lung cancer are equivalent: An analysis of 196 patients at a single, high volume institution

Dolan

White

Mazzola

et al. 2020

Journal of Surgical Oncology

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ObjectivesTo determine if superior segmentectomy has equivalent overall (OS), disease‐free (DFS), and locoregional‐recurrence‐free survival (LRFS) to lower lobectomy for early‐stage non‐small‐cell lung cancer (NSCLC) in the superior segment.MethodsWe retrospectively reviewed all Stage 1 lower lobectomies for superior segment lesions and superior segmentectomies at our hospital from 2000 to 2018. Comparison statistics and Cox hazard modeling were performed to determine differences between groups and attempt to identify risk factors for OS, DFS, and LRFS.ResultsSuperior segmentectomy patients, compared with lower lobectomy patients, had more current smokers, worse forced expiratory volume in 1 s percentage, radiologic emphysema scores, clinically and pathologically smaller tumors, and more occurrences of 0 lymph nodes examined. Outcomes for superior segmentectomy compared with lower lobectomy were equivalent for 5‐year OS (67.0% vs. 75.1%, p = 0.70), DFS (56.9% vs. 60.4%, p = 0.59), and LRFS (87.9% vs. 91.3%, p = 0.46). Multivariable Cox modeling lacked utility due to no outcome differences.ConclusionsIn well‐selected patients, superior segmentectomies can have equivalent OS, DFS, and LRFS compared with lower lobectomies of superior segment tumors for early stage lung cancer. Further data are needed to provide better risk estimates.

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Location of stage I–III non‐small cell lung cancer and survival rate: Systematic review and meta‐analysis

Cited by 43 publications

References 37 publications

Identification of Resectable N2 in NSCLC: A Single Center Experience and Review of the SEER Database

Identification of Resectable N2 in NSCLC: A Single Center Experience and Review of the SEER Database

Factors associated with overall survival in patients with non-squamous NSCLC in New Zealand: A comparative analysis by EGFR gene mutation status

Outcomes of superior segmentectomy versus lower lobectomy for superior segment Stage I non‐small‐cell lung cancer are equivalent: An analysis of 196 patients at a single, high volume institution

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