Survival following segmentectomy or lobectomy in elderly patients with early-stage lung cancer

Abstract

PurposeTo determine the survival following segmentectomy versus lobectomy in elderly patients with early-stage non-small cell lung cancer (NSCLC).MethodsWe identified 12324 elderly (≥ 70 years) patients with stage I ≤ 3 cm NSCLC in the Surveillance, Epidemiology and End Results (SEER) database. Propensity score methods were used to balance baseline characteristics of patients undergoing segmentectomy or lobectomy. Overall survival (OS) and lung cancer-specific survival (LCSS) of patients treated with segmentectomy versus lobectomy were compared in Cox regression models after adjusting, stratifying or matching patients based on propensity scores.ResultsCox models adjusting, stratifying or matching propensity scores all showed that patients treated with segmentectomy had significantly worse OS and LCSS compared to lobectomy. Subgroup analysis of patients with tumors ≤ 2cm, aged ≥ 75 years, or had ≥ 7 lymph nodes examined also revealed survival advantage associated with lobectomy.ConclusionElder age alone could not justify the application of segmentectomy in early-stage lung cancer. Prospective randomized trials are warranted to validate our results.

Survival improvement in patients with non–small cell lung cancer between 1983 and 2012: Analysis of the Surveillance, Epidemiology, and End Results database

“…3,4 Although previous studies have investigated NSCLC outcomes, they tended to evaluate subgroups of patients, such as patients from specific regions, of specific ages, or who underwent surgery, or to focus on the effects of specific histological type or stage on survival. [5][6][7][8][9][10][11] In addition, accumulating evidence of significant racial and socioeconomic status (SES) disparities in the U.S. health care system has been attracting increased attention. We used period analysis in this study to demonstrate the shift in survival time in each decade between 1983 and 2012 and to determine the impacts of race, sex, age, and SES on the survival rates in patients with NSCLC, using data from the SEER program of the National Cancer Institute.…”

COUNTERPOINT: Should Segmentectomy Rather Than Lobectomy Be the Operation of Choice for Early-Stage Non-small Cell Lung Cancer? No

“…Thus, older age alone should not justify segmentectomy in early-stage NSCLC. 12 A recent meta-analysis, focused on patients with medical comorbidities or cardiopulmonary limitations, discovered that overall survival was equivalent only in patients who could tolerate segmentectomies or lobectomies, whereas it was significantly worse in compromised patients and could represent a reflection of noncancer-related deaths in a frail cohort who could not tolerate lobectomy. 8 Segmentectomies proved to have a more favorable prognosis due to variables other than the volume of resection only (tumors < 2 cm, peripherally located, ground-glass opacity on imaging).…”

VATS segmentectomy: an underused option?

“…Other retrospective monocentric (9). A Chinese work based on SEER Database enrolling more than 12,000 cases, found worse overall and lung cancer specific survival in segmentectomy compared to lobectomy in elderly patients (10). Propensity matched studies included the Landreneau et al paper, published in 2014, that showed the same OS and DFS in an enrolling 312 segmentectomies and 312 lobectomies (11).…”