Outcomes with segmentectomy versus lobectomy in patients with clinical T1cN0M0 non–small cell lung cancer

Chan, Ernest G.; Chan, Patrick; Mazur, Summer; Normolle, Daniel P.; Luketich, James D.; Landreneau, Rodney J.; Schuchert, Matthew J.

doi:10.1016/j.jtcvs.2020.03.041

Cited by 51 publications

(51 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For the surgical process in our study, we found that before PSM, regardless of OS or CSS, lobectomy had a better outcome than segmentectomy to treat early T (> 2 cm and ≤ 3 cm) N0N0 NSCLC lung cancer. However, after PSM, and similar to recent studies [24], no signi cant differences in patient survival were seen between those receiving lobectomy vs. segmentectomy. Our research shows that for the T (> 2 cm and ≤ 3 cm) N0N0 stage, segmentectomy and lobectomy achieved the same clinical bene t and prognoses for OS and LCSS in NSCLC patients.…”

Section: Discussionsupporting

confidence: 85%

Lobectomy Versus Segmentectomy in Patients with Stage T (>2 cm and ≤3 cm) N0M0 Non-small Cell Lung Cancer: A Propensity Score Matching Study

Wang¹,

Ren³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Whether lung segmentectomy is a safe and effective surgical treatment in patients with early non-small cell lung cancer (NSCLC) remains controversial. We have therefore reviewed the clinicopathologic characteristics and survival outcomes of patients receiving a lobectomy vs. segmentectomy to treat early T (>2 cm and ≤3 cm) N0M0 NSCLC.Methods: We obtained data from the Surveillance, Epidemiology, and End Results (SEER) database for patients who underwent lobectomy or segmentectomy between 2004 and 2015. To reduce bias and imbalance between the treatment groups, propensity score matching (PSM) analysis was performed. We used Kaplan-Meier curves to estimate overall survival (OS) and lung cancer-speciﬁc survival (LCSS), performed univariate and multivariate Cox proportional hazards regression analyses to identify independent prognostic factors for OS and CSS, and applied the Cox proportional hazards model to create forest plots. Results: A total of 5783 patients from the SEER database were included. Of these, 5531 patients underwent lobectomy, and 252 patients underwent segmentectomy. Before matching, both univariate and multivariate Cox regression analyses showed that patients who underwent lobectomy had better OS (hazard ratio [HR]: 1.561; 95% confidence interval [CI] 1.292-1.885; P <0.001) and LCSS (HR: 1.551; 95% CI 1.198-2.009; P=0.001) than patients who underwent segmentectomy. However, survival differences between the groups were not significant; OS (P=0.160) and LCSS (P=0.097) after matching. Regression analyses revealed that age, sex, lymph node dissection, and grade were independent predictors of OS and LCSS (P <0.05).Conclusions: For patients with stage T (>2 cm and ≤3 cm) N0M0 non-small cell lung cancer, segmentectomy can achieve the same OS and LCSS compared with lobectomy. A large number of patients require further long-term follow-up analyses.

show abstract

Section: Discussionsupporting

confidence: 85%

Lobectomy Versus Segmentectomy in Patients with Stage T (>2 cm and ≤3 cm) N0M0 Non-small Cell Lung Cancer: A Propensity Score Matching Study

Wang¹,

Ren³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Notably, stage IA NSCLC with a tumor size of >20-30 mm has not been included in the inclusion criteria of the RCTs mentioned above. In addition, few retrospective studies have assessed the potential utility of segmental resection for this specific population (3,9). In a comparison of propensityscore matched cohorts (37 pairs), Kamigaichi et al observed no significant differences in recurrence-free survival (RFS) or overall survival (OS) for solid-dominant clinical stage IA lung tumors measuring 21-30 mm when lobectomy and segmental resection were compared (3).…”

Section: Introductionmentioning

confidence: 99%

Segmental resection is associated with decreased survival in patients with stage IA non-small cell lung cancer with a tumor size of 21–30 mm

Zhang

et al. 2021

Transl Lung Cancer Res

View full text Add to dashboard Cite

Background: The feasibility of segmental resection for early-stage non-small cell lung cancer (NSCLC) is still controversial. This study aimed to compare survival outcomes following lobectomy and segmental resection in patients with pathological T1cN0M0 (tumor size 21-30 mm) NSCLC.Methods: Patients diagnosed between 1998 and 2016 with pathological stage IA NSCLC and with tumors measuring 21-30 mm were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The observational outcomes were cancer-specific survival (CSS) and overall survival (OS) at 5 years. Univariate survival analysis was carried out to identify potential prognostic factors of prolonged survival.Cox proportional hazards model was used to adjust for confounding factors. Additionally, pairwise comparisons were conducted between lobectomy and segmental resection for CSS and OS, and forest plots were drawn.Results: Of the 9,580 patients analyzed, 400 patients (4.2%) underwent segmental resections. Patients with older age (P<0.001), smaller tumors (P<0.001), and left-sided tumors (P=0.002) were more likely to receive segmental resection. No difference was found in the operative mortality rates between the segmental resection group and the lobectomy group (1.0% vs. 1.2%, P=0.707). The CSS (HR, 1.429; 95% CI, 1.166-1.752; P=0.001) and OS (HR, 1.348; 95% CI, 1.176-1.544; P<0.001) in the segmental resection group were significantly worse than those in the lobectomy group. Subgroup analyses by age, year of diagnosis, sex, tumor size, histology, grade, and the number of dissected lymph nodes also confirmed that lobectomy was associated with improved CSS and OS.Conclusions: Lobectomy and thorough removal of lymph nodes should continue to be the recommended standard of care for patients with surgically resectable stage IA NSCLC with tumor size of 21-30 mm.

show abstract

“…In medically operable patients, current guidelines advise an anatomic lung resection with systematic mediastinal lymph node dissection as the gold standard of treatment in patients with early-stage NSCLC [11][12][13]. However, there is a growing interest for limited surgery by means of segmentectomy or sublobar resection, fueled by evidence indicating oncological equivalence of these sublobar resections and lobectomy in selected patient groups with early-stage cN0 NSCLC [14][15][16]. Furthermore, non-surgical modalities such as stereotactic ablative body radiotherapy (SABR) are increasingly proposed as potential alternative to surgery for early-stage NSCLC even in the absence of pathological proof [17].…”

Section: Introductionmentioning

confidence: 99%

Occult lymph node metastases in clinical N0/N1 NSCLC; A single center in-depth analysis

et al. 2020

View full text Add to dashboard Cite

Lymph node staging in patients with non-small cell lung cancer is crucial for determining prognosis and treatment. Our objective was to evaluate the clinical-to pathological agreement of guideline-concordant nodal staging in patients with resectable NSCLC and assess occurrence and distribution of occult lymph node metastases (OLM). Materials and methods: In a retrospective single center cohort study (n = 390), we analyzed all surgically treated NSCLC patients from January 2015 until April 2019. Patients were classified into subgroups (1) mediastinal staging by PET-CT/CT-scan (IMAGE-group) or (2) invasive staging by endobronchial ultrasound and mediastinoscopy (INVAS-group). Agreement between final clinical (cN) and pathological nodal stage (pN) and the presence and location of OLM are analyzed. Results: Agreement between cN-and pN-stage was 86.3 % in the IMAGE-group (n = 117) and 50.9 % in the INVAS-group (n = 167). Occult N1 disease was found in 33 patients (16.6 % in cN0) of which 52 % occurred in LN-regions 12− 14. Occult N2 disease was found in 20 cases (6.5 % in cN0 and 12.7 % in cN1). Combined, 23.1 % of all pre-operatively cN0-staged patients (n = 46/199) had OLM (pN+), of which 12.1 % (24/199) had metastases in regions 5-6 and/or 12− 14. Of all patients with OLM, 50.0 % (23/46) had primary tumors ≤30 mm. Conclusion: OLM are frequently identified in clinically N0/N1 NSCLC, also in tumors <3 cm, and often in regions beyond reach of current staging techniques. These findings should be addressed when non-surgical treatment or sub-lobar resections are considered for early stage lung cancer.

show abstract

Outcomes with segmentectomy versus lobectomy in patients with clinical T1cN0M0 non–small cell lung cancer

Cited by 51 publications

References 29 publications

Lobectomy Versus Segmentectomy in Patients with Stage T (>2 cm and ≤3 cm) N0M0 Non-small Cell Lung Cancer: A Propensity Score Matching Study

Lobectomy Versus Segmentectomy in Patients with Stage T (>2 cm and ≤3 cm) N0M0 Non-small Cell Lung Cancer: A Propensity Score Matching Study

Segmental resection is associated with decreased survival in patients with stage IA non-small cell lung cancer with a tumor size of 21–30 mm

Occult lymph node metastases in clinical N0/N1 NSCLC; A single center in-depth analysis

Contact Info

Product

Resources

About

Outcomes with segmentectomy versus lobectomy in patients with clinical T1cN0M0 non–small cell lung cancer

Cited by 51 publications

References 29 publications

Lobectomy Versus Segmentectomy in Patients with Stage T (&gt;2 cm and ≤3 cm) N0M0 Non-small Cell Lung Cancer: A Propensity Score Matching Study

Lobectomy Versus Segmentectomy in Patients with Stage T (&gt;2 cm and ≤3 cm) N0M0 Non-small Cell Lung Cancer: A Propensity Score Matching Study

Segmental resection is associated with decreased survival in patients with stage IA non-small cell lung cancer with a tumor size of 21–30 mm

Occult lymph node metastases in clinical N0/N1 NSCLC; A single center in-depth analysis

Contact Info

Product

Resources

About

Lobectomy Versus Segmentectomy in Patients with Stage T (>2 cm and ≤3 cm) N0M0 Non-small Cell Lung Cancer: A Propensity Score Matching Study

Lobectomy Versus Segmentectomy in Patients with Stage T (>2 cm and ≤3 cm) N0M0 Non-small Cell Lung Cancer: A Propensity Score Matching Study