Recurrence and Survival Outcomes After Anatomic Segmentectomy Versus Lobectomy for Clinical Stage I Non–Small-Cell Lung Cancer: A Propensity-Matched Analysis

Abstract

A B S T R A C T PurposeAlthough anatomic segmentectomy has been considered a compromised procedure by many surgeons, recent retrospective, single-institution series have demonstrated tumor recurrence and patient survival rates that approximate those achieved by lobectomy. The primary objective of this study was to use propensity score matching to compare outcomes after these anatomic resection approaches for stage I non-small-cell lung cancer. Patients and MethodsA retrospective data set including 392 segmentectomy patients and 800 lobectomy patients was used to identify matched segmentectomy and lobectomy cohorts (n ϭ 312 patients per group) using a propensity score matching algorithm that accounted for confounding effects of preoperative patient variables. Primary outcome variables included freedom from recurrence and overall survival. Factors affecting survival were assessed by Cox regression analysis and Kaplan-Meier estimates. ResultsPerioperative mortality was 1.2% in the segmentectomy group and 2.5% in the lobectomy group (P ϭ .38). At a mean follow-up of 5.4 years, comparing segmentectomy with lobectomy, no differences were noted in locoregional (5.5% v 5.1%, respectively; P ϭ 1.00), distant (14.8% v 11.6%, respectively; P ϭ .29), or overall recurrence rates (20.2% v 16.7%, respectively; P ϭ .30). Furthermore, when comparing segmentectomy with lobectomy, no significant differences were noted in 5-year freedom from recurrence (70% v 71%, respectively; P ϭ .467) or 5-year survival (54% v 60%, respectively; P ϭ .258). Segmentectomy was not found to be an independent predictor of recurrence (hazard ratio, 1.11; 95% CI, 0.87 to 1.40) or overall survival (hazard ratio, 1.17; 95% CI, 0.89 to 1.52). ConclusionIn this large propensity-matched comparison, lobectomy was associated with modestly increased freedom from recurrence and overall survival, but the differences were not statistically significant. These results will need further validation by prospective, randomized trials (eg, Cancer and Leukemia Group B 140503 trial).

Lobectomy and limited resection in small-sized peripheral non-small cell lung cancer

“…In prospective nonrandomized studies that reported similar postoperative outcomes for limited resection and lobectomy, only a small percentage of patients (11.5-18.9%) underwent wedge resection in their limited resection groups (6,8). Moreover, in a recent study of large propensity-matched comparison, non-inferior postoperative survival and recurrence rate in patients who underwent segmentectomy were demonstrated in clinical stage I NSCLC (13). Therefore, the unfavorable postoperative survival in the limited resection group of the LCSG study may reflect the relatively high percentage of patients in this group who underwent wedge resection.…”

“…Small tumors with the pathological characteristics of adenocarcinoma in situ (AIS) (10) as indicated by ground-glass opacity (GGO) in CT scans, are considered appropriate for limited resection, especially for wedge resection (5,7,9) although a higher locoregional recurrence rate associated with wedge resection when compared to segmentectomy in small NSCLC patients was reported in previous retrospective studies on one hand (11,12). Moreover, both lobectomy and limited resection produced similar postoperative outcomes in patients with small NSCLCs regardless of their radiological characteristics (6,8,13).…”

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

“…Interestingly, there was no difference in survival for more limited resection in those patients 71 and older. 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).…”

Accuracy of the IASLC/ATS/ERS histological subtyping of stage I lung adenocarcinoma on intraoperative frozen sections

“…15 Some surgeons have suggested that small (usually less than 2 cm) peripheral lung adenocarcinoma can be treated with a limited resection with survival and recurrence rate similar to lobectomy. [16][17][18] Recently, Nitadori et al 10 reported that the presence of 5% or greater of micropapillary component in lung adenocarcinoma measuring up to 2 cm in diameter and treated with limited surgical resection was associated with an increased risk of recurrence. This observation has potential practical implications for pathologists, who have to make an effort to accurately recognize histological patterns on the frozen sections.…”