Segmental resection is associated with decreased survival in patients with stage IA non-small cell lung cancer with a tumor size of 21–30 mm

Abstract

Background: The feasibility of segmental resection for early-stage non-small cell lung cancer (NSCLC) is still controversial. This study aimed to compare survival outcomes following lobectomy and segmental resection in patients with pathological T1cN0M0 (tumor size 21-30 mm) NSCLC.Methods: Patients diagnosed between 1998 and 2016 with pathological stage IA NSCLC and with tumors measuring 21-30 mm were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The observational outcomes were cancer-specific survival (CSS) and overall survival (OS) at 5 years. Univariate survival analysis was carried out to identify potential prognostic factors of prolonged survival.Cox proportional hazards model was used to adjust for confounding factors. Additionally, pairwise comparisons were conducted between lobectomy and segmental resection for CSS and OS, and forest plots were drawn.Results: Of the 9,580 patients analyzed, 400 patients (4.2%) underwent segmental resections. Patients with older age (P<0.001), smaller tumors (P<0.001), and left-sided tumors (P=0.002) were more likely to receive segmental resection. No difference was found in the operative mortality rates between the segmental resection group and the lobectomy group (1.0% vs. 1.2%, P=0.707). The CSS (HR, 1.429; 95% CI, 1.166-1.752; P=0.001) and OS (HR, 1.348; 95% CI, 1.176-1.544; P<0.001) in the segmental resection group were significantly worse than those in the lobectomy group. Subgroup analyses by age, year of diagnosis, sex, tumor size, histology, grade, and the number of dissected lymph nodes also confirmed that lobectomy was associated with improved CSS and OS.Conclusions: Lobectomy and thorough removal of lymph nodes should continue to be the recommended standard of care for patients with surgically resectable stage IA NSCLC with tumor size of 21-30 mm.

Local control and short-term outcomes after video-assisted thoracoscopic surgery segmentectomy versus lobectomy for pT1c pN0 non-small-cell lung cancer

“…Indeed, 2 studies did a retrospective propensity-matched analysis showing similar OS and recurrence-free survival when comparing both groups for the treatment of T1c NSCLC with a median follow-up of 4–5 years [ 6 , 7 ]. On the other hand, Surveillance, Epidemiology and End Results database revealed a decreased OS after segmentectomy (hazard ratio 1.348; P < 0.001) for NSCLC measuring 21–30 mm [ 8 ]. In this study, the follow-up was quite short (median 48 months) and it is to note that the number of resected lymph node was quite low in the segmentectomy group (median 4.4), which might have had an influence on the measured difference in OS [ 8 ].…”

“…Two retrospective propensity score-matched study including NSCLC of 2–3 cm found no difference in terms of overall survival (OS) and recurrence-free survival between patients benefiting lobectomy when compared to segmentectomy [ 6 , 7 ]. On the other hand, Yu et al [ 8 ] revealed a significantly worse survival in patients undergoing segmentectomy. Thus, the balance of preserving lung function by performing a parenchyma-sparing segmental resection for NSCLC >2 cm with the potential negative impact on survival and recurrence remains unclear.…”

An Automatic Segmentation Method for Lung Tumor Based on Improved Region Growing Algorithm

“…We use the prior information on lung tumors to determine the initial seed point of the improved region growing algorithm, so users do not need to specify the initial seed point. Yu et al [ 28 ] showed that lobectomy is a recommended treatment standard for tumors with a size of 21–30 mm. In the latest international tumor, node, and metastasis (TNM) staging standard for lung cancer (8th edition) [ 29 ], the size range of the T1c stage is (>2 to ≤3 cm).…”

Sol Üst Lob Evre I Akciğer Kanserli Hastalar İçin Sol Üst Lobektomi Aşırı Tedavi mi? Propensity Skor Analizi

“…TNM Evreleme sisteminde; tümör çapındaki her bir santimetrelik artışın daha kötü prognoz göstergesi olması nedeniyle 5 cm'ye kadar olan tümör boyutları her bir santimetrede bir kademe yükselecek şekilde beş gruba ayrıldı (T1a, T1b, T1c, T2a, T2b) 16 .Tümör boyutunun anatomik akciğer rezeksiyonu sonrası sonuçlara etkisini araştıran çalışmalarda ise farklı sonuçlara ulaşıldı. Yu ve arkadaşları tümör boyutu 21-30 mm olan hastalarda segmental rezeksiyonun daha kötü sağkalım ile ilişkili olduğu için lobektomi yapılması önerdiler 17 . Diğer çalışmalarda ise segmentektomi ile lobektomi arasında benzer sonuçlar elde edildi 18,19 .…”