Survival After Sublobar Resection vs. Lobectomy for Clinical Stage IA Lung Cancer : An Analysis from the National Cancer Data Base
Menée à partir de données portant sur 13 606 patients atteints d'un cancer du poumon non à petites cellules de stade T1A N0 traité entre 2003 et 2011, cette étude évalue, du point de vue de la mortalité à 30 jours et de la survie globale, l'intérêt d'une résection sublobaire (segmentectomie ou résection cunéiforme) par rapport à une lobectomie
Background : Recent data have suggested possible oncologic equivalence of sublobar resection with lobectomy for early stage NSCLC.Our aim was to evaluate and compare short and long term survival for these surgical approaches. Methods : This retrospective cohort study utilized the National Cancer Data Base. Patients undergoing lobectomy, segmentectomy,or wedge resection for preoperative clinical T1A N0 NSCLC from 2003-2011 were identified.Overall survival (OS) and 30-day mortality were analyzed using multivariable Cox proportional hazards models,logistic regression models,and propensity score matching.Further analysis of survival stratified by tumor size, facility type, number of lymph nodes examined, and surgical margins was performed. Results : A total of 13,606 patients were identified. After propensity score matching, 987 patients remained in each group. Both segmentectomy and wedge resection were associated with significantly worse OS when compared with lobectomy (HR 1.70 and 1.45, respectively, both p < 0.001), with no difference in 30 day mortality. Median OS for lobectomy, segmentectomy, and wedge resection were 100, 74, and 68 months, respectively (p < 0.001). Finally, sublobar resection was associated with increased likelihood of positive surgical margins, lower likelihood of having more than 3 lymph nodes examined, and significantly lower rates of nodal upstaging. Conclusion : In this large national-level, clinically diverse sample of clinical T1ANSCLC patients, wedge and segmental resectionswere shown to have significantly worse OS compared to lobectomy.Further patients undergoing sublobar resection were more likely to have inadequate lymphadenectomy and positive margins. On going prospective study taking into account LN upstaging and margin status is still needed.