Survival following lobectomy vs limited resection for stage I lung cancer: a meta-analysis

Nakamura, Hiroki; Kawasaki, Norihito; Taguchi, Masahiko; Kabasawa, Kazuyuki

doi:10.1038/sj.bjc.6602414

Cited by 154 publications

(78 citation statements)

References 36 publications

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“…A recent meta-analysis on survival following lobectomy and limited resection for stage I lung cancer confirmed the results of the randomised trial: there were no statistically significant differences between the two groups, but there was a small benefit in the lobectomy group. However, there was some interstudy heterogeneity that suggests that the results should be interpreted with caution [12]. At the same time, the routine use of computed tomography (CT) in clinical practice and in some screening programmes increased the number of small peripheral lung cancers, both in the form of solid or partly solid lesions, and pure bronchioloalveolar carcinomas as ground-glass opacities (GGOs), for which a lobectomy seems excessive.…”

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confidence: 99%

Sublobar resection for lung cancer

Rami–Porta

Tsuboi²

2009

Eur Respir J

102

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Sublobar resection for small lung cancers has been debated frequently and is still a controversial issue. The only randomised trial comparing lobectomy with sublobar resections found a significantly higher recurrence rate for the latter, but failed to show significant differences in survival, although survival was better for the lobectomy group. One meta-analysis and several nonrandomised comparisons have confirmed these results. In general, lobectomy and sublobar resections have similar 5-yr survival rates. Local recurrence after wedge resection is higher than after segmentectomy. However, for patients aged .71 yrs, lobectomy and wedge resection are associated with similar survival. For tumours of f2 cm, segmentectomy is equivalent to lobectomy, but survival after segmentectomy is worse if performed for larger tumours. For both segmentectomy and wedge resection, tumour margins should be o1 cm wide to avoid recurrence. For pure bronchioloalveolar carcinoma of f2 cm, diagnosed intraoperatively with certainty, sublobar resection seems equivalent to lobectomy, and because there is no nodal involvement, systematic nodal dissection may not be necessary. In case of doubt, however, lobectomy with systematic nodal dissection will ensure complete resection and adequate staging. More randomised trials are needed to confirm all these issues.

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confidence: 99%

Sublobar resection for lung cancer

Rami–Porta

Tsuboi²

2009

Eur Respir J

102

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“…This indicated that segmentectomy should not be the first choice in the treatment of T1N0M0 NSCLC patients. However, in recent years an increasing number of retrospective studies and meta-analyses proposed that limited resection may be superior to lobectomy for early-stage NSCLC patients (7,8). Segmentectomy may be chosen for patients who are intolerant of lobectomy or for palliative purposes (9).…”

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confidence: 99%

Long-term outcomes of stage I NSCLC (≤3 cm) patients following segmentectomy are equivalent to lobectomy under analogous extent of lymph node removal: a PSM based analysis

Qu¹,

Wang²,

Zhang³

et al. 2017

J. Thorac. Dis.

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Background: Segmentectomy has the advantage of less complications, but might have less lymph node sampling and higher risk of recurrence. We aimed to compare treatment outcome between two surgical options, and explore the effect of regional lymph node removal on the prognostic difference. Methods:We retrospectively analyzed data of stage I non-small cell lung cancer (NSCLC) (≤3 cm in size) patients who underwent either segmentectomy, or lobectomy, collected from the Surveillance, Epidemiology and End Results (SEER) database, from 2003 to 2013. The primary endpoints were overall survival (OS) and lung cancer-specific survival (LCSS). We also collected data from Shandong Provincial Hospital as validation.Results: Ultimately 1,156 patients treated by segmentectomy and 17,748 patients treated by lobectomy from SEER database were included in the analysis. Overall, segmentectomy was inferior to lobectomy in terms of OS [hazard ratio (HR): 1.316 (1.186-1.461), P<0.001] and LCSS [HR: 1.310 (1.142-1.504), P<0.001]. When the removal of regional lymph nodes (LN) was taken into consideration, no significant difference was found in OS and LCSS, in any Scope of Regional Lymph Node Surgery layer (0, 1-3, more than 3, and biopsy/sentinel layer, all P>0.05). After propensity score matching (PSM), there was no difference between segmentectomy and lobectomy in OS [HR: 1.081 (0.937-1.248), P=0.286] and LCSS [HR: 1.039 (0.861-1.253), P=0.692]. Only sex, age, histology, summary stage, differentiation, tumor size, and radiation still remained as independent prognostic factors for both OS and LCSS. For validation part, there was no significantly prognostic difference between lobectomy and sublobectomy group in overall (P=0.132) and each regional LN removed layer (0, 1-3, more than 3 layers: all P>0.05).Conclusions: Segmentectomy with proper lymph node resection or sampling could be a good alternative to lobectomy. IntroductionLung cancer is the leading cause of cancer-related death (26.5% of all) and has the second highest annual incidence in both males and females (13.3% for each), in the United States (1). More than half of lung cancer patients (57%) have distant metastasis at diagnosis, and overall 5-year relative survival rate is as low as 18% (1). Lung cancer can be divided into small cell lung cancer (SCLC, less than 20%) and non-small cell lung cancer (NSCLC, more than 80%), with entirely different treatment strategies and prognosis (2). Treatment strategies mainly include surgery, chemotherapy, radiotherapy, targeted therapy, and immunotherapy (2). Therein, approximately 69% of NSCLC patients with stages I and II are treated by surgery, compared to only 9% of patients with stages III and IV (2). Surgery is considered the best treatment option for early stage lung cancer, and anatomical lobectomy with N1 and at least three N2 stations sampling or dissection has become the standard surgery for early NSCLC patients (3). Minimally invasive video-assisted thoracoscopic lobectomy is also preferred for stage I NSCLC patients (4...

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“…Other studies observing Stage I NSCLC have shown no difference in survival time between patients undergoing wedge resection and those undergoing lobectomy. A meta-analysis of these studies and others has also reached the same conclusion [24].…”

Section: Discussionmentioning

confidence: 53%

Individualized higher dose of 70–75 Gy using five-fraction robotic stereotactic radiotherapy for non-small-cell lung cancer: A feasibility study

Brown

Fayad²,

Hevezi³

et al. 2011

Computer Aided Surgery

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Objective: To determine whether robotic stereotactic radiotherapy of 70-75 Gy delivered in five fractions results in an improved therapeutic ratio, compared with three fractions, in the treatment of peripheral non-small-cell lung cancer (NSCLC), in which case doses of up to 85 Gy in five fractions may be feasible. Materials and Methods: Between December 2006 and May 2010, 20 patients (9 female, 11 male, aged 65 to 88) were treated using the CyberKnife Õ Robotic Radiosurgery System for NSCLC with doses ranging from 67 Gy to 75 Gy based on location, histopathological type, grade of histopathological differentiation, tumor diameter/volume, and normal tissue constraints, with the doses being delivered in five fractions over 5 to 8 days. Tumor diameters ranged from 1.5 cm to 3.4 cm (median: 2.5 cm). Patients with Stage I to IV NSCLC were treated, and the results and observations were analyzed for clinical characteristics and outcomes including toxicity. All patients, except one who had refused surgery, had co-morbid conditions that precluded a lobectomy. Results: Twenty patients were followed every three months by positron emission tomography/computed tomography (PET/ CT). Mean follow-up was 23 months (range: four to 58 months). Local control was achieved in all treated tumors. Three patients expired, and three developed new regional metastases, none of which was within the planning target volume (PTV). The remainder of the patients demonstrated no evidence of recurrence or continued growth detectable by PET/ CT. There was no toxicity above Grade 1. Conclusions: It is feasible to treat peripheral NSCLC with individualized maximal tolerable doses ranging from 67 Gy to 75 Gy in five fractions chosen on the basis of location, histopathological type, grade of histopathological differentiation, tumor diameter/volume, and normal tissue constraints.

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Survival following lobectomy vs limited resection for stage I lung cancer: a meta-analysis

Cited by 154 publications

References 36 publications

Sublobar resection for lung cancer

Sublobar resection for lung cancer

Long-term outcomes of stage I NSCLC (≤3 cm) patients following segmentectomy are equivalent to lobectomy under analogous extent of lymph node removal: a PSM based analysis

Individualized higher dose of 70–75 Gy using five-fraction robotic stereotactic radiotherapy for non-small-cell lung cancer: A feasibility study

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