Surgery for advanced-stage non-small cell lung cancer: lobectomy or sub-lobar resection?

Abstract

Background: Metastatic non-small cell lung cancer (NSCLC) has many comorbidities, such as chronic obstructive pulmonary disease, coronary heart disease, and older age-related comorbidities. A survival benefit was observed in such patients who underwent surgery for selected oligometastatic disease. However, to the best of our knowledge, there is no evidence to support whether lobectomy (compared with sub-lobar resection) would further prolong these patients' lives.Methods: Patients with metastatic NSCLC who underwent primary tumor resection were identified from the Surveillance, Epidemiology, and End Results (SEER) database and then divided into lobectomy and sub-lobar resection groups. Propensity score matching (PSM, 1:1) was performed to match the baseline characteristics of the two groups. Cancer-specific survival (CSS) was estimated.Results: In total, 24,268 patients with metastatic NSCLC were identified; 4,114 (16.95%) underwent primary tumor surgery, and of these, 2,045 (49.71%) underwent lobectomy and 1,766 (42.93%) underwent sub-lobar resection. After PSM, 644 patients in each group were included. Lobectomy was independently correlated with longer median CSS time [hazards ratio (HR): 0.70, 95% confidence interval (CI): 0.61-0.80, P<0.001]. The 1, 2, and 3-year survival rates after PSM also favored the lobectomy group. However, no significant survival difference was found for wedge resection and segmentectomy (HR: 0.96, 95% CI: 0.70-1.31, P=0.490). The 1-, 2-, and 3-year survival rates after PSM also exhibited no difference within the sub-lobar group. We explored whether lymph node dissection would provide additional survival benefits for stage IV NSCLC patients. According to the multivariate Cox analysis of the matched population, lymph node dissection was independently associated with better CSS (HR: 0.76, 95%

The Prognostic Impact of Lymph Node Dissection on Primary Tumor Resection for Stage IV Non–Small Cell Lung Cancer: A Population-Based Study

“…The LND was performed on the basis of surgery; therefore, the relation between LND and surgery is worth discussing. The previous studies showed that surgery was associated with more survival benefits in patients with stage IV NSCLC with lower T stage as T1-2 ( 26 ) compared with those with higher T, and lobectomy might have better survival versus SLR ( 33 ). This present study suggests LND might benefit stage IV NSCLC patients who underwent surgery with higher T stage like T3-4 and those who received SLR, as compared with the non-LND.…”

Five‐year survival of resectable stage IIIA non‐small cell lung cancer in Brazil

“…10 which may be challenging to deliver to such patients. 14,24,28,[32][33][34][35] In real-life studies, patients with NSCLC usually tend to be older and have a wide range of age-related comorbidities, such as chronic obstructive pulmonary disease and coronary heart disease.…”

“…In recent years, growing evidence supports the substantial importance of tumor resection in locally advanced NSCLC patients, which may contribute to better survival outcomes 11,14,22,23 . Multiple studies have confirmed a higher 5‐year disease‐free survival in patients who underwent chemoradiotherapy plus surgery or chemotherapy plus surgery versus standard definitive chemoradiotherapy in the OS 11,24–28 .…”

“…Albain et al reported a 5‐year OS of 36% in their randomized trial comparing stage III NSCLC patients treated with chemotherapy plus radiotherapy and surgery versus chemotherapy plus radiotherapy only. Pless et al reported approximately 38% 5‐year OS for patients with stage III NSCLC undergoing chemotherapy plus radiotherapy plus surgery 7,12,14,24,29–32 …”

“…The surgery may be an option based mainly on the resectability and number of mediastinal lymph node chains affected. However, other factors require an accurate selection of candidates, such as the year of the start of the treatment, a person's overall health, and lung function 1,11,13–17 …”