Second Primary Lung Cancers Demonstrate Similar Survival With Wedge Resection and Lobectomy

Lee, Dong‐Seok; LaChapelle, Christopher R; Taioli, Emanuela; Kaufman, Andrew; Wolf, Andrea; Nicastri, Daniel G.; Flores, Raja M.

doi:10.1016/j.athoracsur.2019.06.023

Cited by 20 publications

(18 citation statements)

References 17 publications

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“…21 However, Lee et al concluded that there were similar survival benefits between wedge resection and lobectomy for SPLC. 18 In our study, it seemed that lobectomy for IPLC performed slightly better in survival than sublobar resection, but without significance (Fig 4a). Similarly, there was also no significant difference among the three surgical procedures (wedge resection, segmentectomy and lobectomy) for SPLC (Fig 4b).…”

Section: Discussionmentioning

confidence: 52%

“…It seemed that fewer males intended to suffer SPLC after surgery for IPLC (272 vs. 393), but males showed worse overall survival than females (HR = 1.82, 95% CI: 1.29-2.59, P = 0.001), which was similar to that reported in a previous study. 18 Surprisingly, in our study, the characteristics of resected IPLC could influence the survival outcome of SPLC patients. Patients with IPLC having SCC demonstrated a worse survival than those with ADC (HR = 1.89, 95%CI: 1.17-3.04, P = 0.009).…”

Section: Discussionmentioning

confidence: 54%

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Prognostic study for survival outcome following the treatment of second primary lung cancer in patients with previously resected non‐small cell lung cancer

Han

Chong

et al. 2020

Thoracic Cancer

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Background: Patients who have previously undergone surgical resection of initial primary lung cancer (IPLC) are at high risk of developing second primary lung cancer (SPLC). There are still no standard treatments for SPLC. This study aimed to identify the prognostic factors and compare survival between the different SPLC treatment groups. Methods: SPLC patients in the Surveillance, Epidemiology, and End Results (SEER) database between 2007 and 2016 were retrospectively reviewed. Prognostic factors for SPLC were identified, using the least absolute shrinkage and selection operator (LASSO) regression and univariate Cox analysis to select variables for multivariate Cox analysis. Kaplan-Meier method plus log-rank test and restricted mean survival time (RMST) were used to compare survival outcome. Results: A total of 665 SPLC patients were finally enrolled into the study. Multivariate Cox regression analysis revealed that male vs. female (HR = 1.82, 95% CI: 1.29-2.59, P = 0.001), tumor size of SPLC ≥1 cm vs. <1 cm (HR = 1.80, 96% CI: 1.07-3.02, P = 1.028), IPLC characteristics of squamous cell carcinoma vs. adenocarcinoma (HR = 1.89, 95% CI: 1.17-3.04, P = 0.009), clinical stage II vs. stage I (HR = 2.60, 95% CI: 1.08-6.27, P = 0.033), and T2 stage vs. T1 stage (HR = 1.68, 95% CI: 1.04-2.72, P = 0.034) indicated worse survival. SPLC patients demonstrated a five-year survival rate of 68.6% and a five-year RMST of 49.4 months. The choice of surgical procedure (wedge resection, segmentectomy and lobectomy) for both IPLC and SPLC had no significant effect on prognosis (P > 0.05). Patients that received radiotherapy for SPLC also demonstrated similar survival when compared with those that underwent surgery (P > 0.05). Conclusions: Radiotherapy and sublobar resection can be considered reasonable alternative treatments for SPLC, especially when patients are unable to tolerate lobectomy.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 54%

Prognostic study for survival outcome following the treatment of second primary lung cancer in patients with previously resected non‐small cell lung cancer

Han

Chong

et al. 2020

Thoracic Cancer

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“…For stage IA SP-NSCLC patients with previous lung cancer-directed surgery, to date, it has not been fully understood whether lobectomy is more conducive to survival than wedge resection. Although several retrospective studies [16][17][18] and a recent SEER-based study [11] have found that lobectomy did not show a signi cant survival advantage over sublobectomy for SPLC patients, these researches still lacked an indepth study on SPLC patients who have undergone radical surgery for primary lung cancer. To better solve this problem and provide references for further clinical research and practice, we carried out this study.…”

Section: Discussionmentioning

confidence: 99%

“…Despite signi cant breakthroughs in the diagnosis and treatment of lung cancer, it has not been determined whether lobectomy has a better survival advantage than wedge resection for patients with early-stage SP-NSCLC, especially those with history of radical surgery for the rst primary lung cancer (FPLC). A recent SEER-based study [11]has reported that SPLC demonstrated similar survival with lobectomy and wedge resection. However, the study did not delve into the differences in survival between the two procedures in various speci c circumstances.…”

Section: Introductionmentioning

confidence: 99%

Survival After Wedge Resection Versus Lobectomy for Stage Ia Second Primary NSCLC with Previous Lung Cancer-Directed Surgery

Song

et al. 2020

Preprint

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Background: The surgical procedure for early-stage second primary non-small cell lung cancer (SP-NSCLC) remains controversial, especially for patients with previous lung cancer-directed surgery. This study aims to compare the survival after wedge resection and lobectomy for these patients. Methods: Stage IA SP-NSCLC patients with clear information were searched from the Surveillance, Epidemiology, and End Results (SEER) database. Cox proportional hazard model, competing risk model and Kaplan-Meier survival curve were used to describe the survival difference between wedge resection and lobectomy. A 1:1 propensity score matching (PSM) method was also performed to reduce the potential impact of confounding factors between the two groups. Results: Of the 320 eligible stage IA SP-NSCLC patients included in this study, 238 (74.4%) patients underwent wedge resection and 82 (25.6%) patients received lobectomy. The 5-year overall survival (OS) was 61.3% with wedge resection and was 66.1% with lobectomy. Both before and after PSM, wedge resection showed similar survival rate and lung cancer specific mortality as lobectomy in the entire cohort. Additionally, in all subgroup analyses, wedge resection demonstrated equivalent survival to lobectomy. However, in the female, sub-lobectomy for FPLC and interval ≤ 24 months subgroups, wedge resection had a higher lung cancer specific mortality than lobectomy (fine-gray test, all p < 0.05). Conclusion: In conclusion, wedge resection was comparable to lobectomy in OS with all relevant parameters. In a few cases, lung cancer specific mortality in wedge resection group was higher than that in lobectomy group.

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“…Shimada et al 84 recommended to resect main cancers (larger size or radiologically invasive) with lobectomy and sub-cancers (any other lung cancers) with sublobectomy. Although Zuin et al 4 revealed lobectomy was superior to sublobectomy for second primary lung cancer with better 5-year survival (57.5% vs 36%; p=0.016), others 8,94 proposed that sublobar resection for the second cancer was safe with acceptable mortality and a 5-year survival rate, especially for patients with limited pulmonary function.…”

Section: Alternative Treatment Options Surgery: Unknown Optimal Procementioning

confidence: 99%

<p>Multiple Primary Lung Cancers: A New Challenge in the Era of Precision Medicine</p>

Zhao¹,

Liu²,

Xie³

et al. 2020

CMAR

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With the widespread implementation of lung cancer screening, more and more patients are being diagnosed with multiple primary lung cancers (MPLCs). In the era of precision medicine, many controversies remain in differentiating MPLCs from intrapulmonary metastasis and the optimum treatment choice, especially in patients exhibiting similar histology. In this review, we summarize common diagnostic criteria and novel discrimination methods with a special emphasis on the emerging value of broad panel next-generation sequencing (NGS) for the diagnosis of MPLCs. We then discuss current advances regarding therapeutic approaches for MPLCs. Radical surgery is the main treatment modality, while stereotactic body radiotherapy (SBRT) is safe and feasible for early-stage MPLC patients with inoperable tumors. In addition, immunotherapy and targeted therapy, particularly epidermal growth factor receptor-tyrosine kinase inhibitors, are emerging therapeutic strategies that are still in their infancy. Characteristics of both genomic profiles and tumor microenvironment are currently being evaluated but warrant further exploration to facilitate the application of targeted systematic therapies in MPLC patients.

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Second Primary Lung Cancers Demonstrate Similar Survival With Wedge Resection and Lobectomy

Cited by 20 publications

References 17 publications

Prognostic study for survival outcome following the treatment of second primary lung cancer in patients with previously resected non‐small cell lung cancer

Prognostic study for survival outcome following the treatment of second primary lung cancer in patients with previously resected non‐small cell lung cancer

Survival After Wedge Resection Versus Lobectomy for Stage Ia Second Primary NSCLC with Previous Lung Cancer-Directed Surgery

<p>Multiple Primary Lung Cancers: A New Challenge in the Era of Precision Medicine</p>

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Second Primary Lung Cancers Demonstrate Similar Survival With Wedge Resection and Lobectomy

Cited by 20 publications

References 17 publications

Prognostic study for survival outcome following the treatment of second primary lung cancer in patients with previously resected non‐small cell lung cancer

Prognostic study for survival outcome following the treatment of second primary lung cancer in patients with previously resected non‐small cell lung cancer

Survival After Wedge Resection Versus Lobectomy for Stage Ia Second Primary&nbsp;NSCLC with Previous Lung Cancer-Directed Surgery

<p>Multiple Primary Lung Cancers: A New Challenge in the Era of Precision Medicine</p>

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Survival After Wedge Resection Versus Lobectomy for Stage Ia Second Primary NSCLC with Previous Lung Cancer-Directed Surgery