Selection of the surgical approach for patients with cStage IA lung squamous cell carcinoma: A population-based propensity score matching analysis

Abstract

BackgroundThis study aimed to conduct a comparative analysis of the survival rates after segmentectomy, wedge resection, or lobectomy in patients with cStage IA lung squamous cell carcinoma (SCC).MethodsWe enrolled 4,316 patients who had cStage IA lung SCC from the Surveillance, Epidemiology, and End Results (SEER) database. The Cox proportional hazards model was conducted to recognize the potential risk factors for overall survival (OS) and lung cancer-specific survival (LCSS). To eliminate potential biases of included patients, the propensity score matching (PSM) method was used. OS and LCSS rates were compared among three groups stratified according to tumor size.ResultsKaplan–Meier analyses revealed no statistical differences in the rates of OS and LCSS between wedge resection (WR) and segmentectomy (SG) groups for patients who had cStage IA cancers. In patients with tumors ≤ 1 cm, LCSS favored lobectomy (Lob) compared to segmentectomy (SG), but a similar survival rate was obtained for wedge resection (WR) and lobectomy (Lob). For patients with tumors sized 1.1 to 2 cm, lobectomy had improved OS and LCSS rates compared to the segmentectomy or wedge resection groups, with the exception of a similar OS rate for lobectomy and segmentectomy. For tumors sized 2.1 to 3 cm, lobectomy had a higher rate of OS or LCSS than wedge resection or segmentectomy, except that lobectomy conferred a similar LCSS rate compared to segmentectomy. Multivariable analyses showed that patients aged ≥75 and tumor sizes of >2 to ≤3 cm were potential risk factors for OS and LCSS, while lobectomy and first malignant primary indicator were considered protective factors. The Cox proportional analysis also confirmed that male patients aged ≥65 to <75 were independent prognostic factors that are indicative of a worse OS rate.ConclusionsThe tumor size can influence the surgical procedure recommended for individuals with cStage IA lung SCC. For patients with tumors ≤1 cm, lobectomy is the recommended approach, and wedge resection or segmentectomy might be an alternative for those who cannot tolerate lobectomy if adequate surgical margin is achievable and enough nodes are sampled. For tumors >1 to ≤3 cm, lobectomy showed better survival outcomes than sublobar resection. Our findings require further validation by randomized controlled trial (RCT) or other evidence.

Systematic review and meta-analysis of segmentectomy vs. lobectomy for stage IA non-small cell lung cancer

“…After searching databases including PubMed, Embase, Web of Science, and Cochrane Library, a total of 10 ( 14 - 17 , 22 - 27 ) articles were included for the final analysis from the initial 1,209 articles. The screening process is detailed in Figure 1 .…”

“…The screening process is detailed in Figure 1 . There were 8 retrospective studies with propensity score matching ( 15 - 17 , 22 - 26 ) and 2 RCTs ( 14 , 27 ). Six articles focused on stage IA ≤2 cm lung cancer, and only one article focused on stage IA of 2–3 cm lung cancer; the other three articles performed subgroup analysis for stage IA lung cancer, which was consistent with our meta-analysis.…”

“…Thus, the findings must be interpreted with caution, and future studies are still needed to further interpret the role of segmentectomy in stage IA lung cancer of 2–3 cm in size. Additionally, we did not further divide the stage IA ≤2 cm group into stage IA ≤1 cm and stage IA of 1–2 cm because there were insufficient data to analyze, but the studies ( 4 , 17 , 30 , 37 ) have demonstrated that sublobectomy can provide similar disease control and oncological outcomes as lobectomy for patients with stage IA ≤1 cm NSCLC.…”

“…However, the lobectomy group reported more deaths due to other diseases, and the local recurrence rate of the segmentectomy group was significantly higher than that of the lobectomy group. Some studies ( 15 - 18 ) have shown lobectomy has a survival advantage over segmentectomy for stage IA NSCLC, especially tumors 2–3 cm in size ( 17 ).…”