Surgery or Non-surgical Treatment of ≤8 mm Non-small Cell Lung Cancer: A Population-Based Study

Abstract

Background: Timing for intervention of small indeterminate pulmonary nodules has long been a topic of debate given the low incidence of malignancy and difficulty in obtaining a definite preoperative diagnosis. We sought to determine survival outcomes of surgical and non-surgical managements in non-small cell lung cancer (NSCLC) ≤8 mm, which may provide a reference for prospective decision-making for patients with suspected NSCLC.Method: A total of 1,652 patients with Stage IA NSCLC ≤8 mm were identified from the Surveillance, Epidemiology, and End Results (SEER) database and categorized into surgery and non-surgery groups. Chi-square test, t-test and Mann-Whitney U test were used to compare the baseline characteristics between groups. Survival curves were depicted using Kaplan-Meier method and compared by log-rank test. Cox proportional hazard model was used for univariate and multivariate analyses. Adjustment of confounding factors between groups was performed by propensity score matching.Results: The surgery and non-surgery groups included 1,438 and 208 patients, respectively. Patients in surgery group demonstrated superior survival outcome than patients in non-surgery group both before [overall survival (OS): HR, 16.22; 95% CI, 11.48–22.91, p < 0.001; cancer-specific survival (CSS): HR, 49.6; 95% CI, 31.09–79.11, p < 0.001] and after (OS: HR, 3.12; 95% CI, 2.40–4.05, p < 0.001; CSS: HR, 3.85; 95% CI, 2.74–5.40, p < 0.001) propensity score matching. The 30-day mortality rates were 3.1 and 12.0% in surgery and non-surgery groups, respectively. Multivariate analysis suggested age, sex, race, tumor size, grade, pathological stage were all independent prognostic factors in patients with ≤8 mm NSCLC. A comparison of surgical resections revealed a survival superiority of lobectomy over sub-lobectomy. In terms of CSS, no statistically significant difference was found between segmentectomy and wedge resection.Conclusion: The current SEER database showed better prognosis of surgical resection than non-surgical treatment in patients with ≤8 mm NSCLC. However, the factors that should be essentially included in the proper propensity-matched analysis, such as comorbidity, cardiopulmonary function and performance status were unavailable and the true superiority or inferiority should be examined further by ongoing randomized trial, especially comparing surgery and stereotactic body irradiation.

Editorial: Bench Research Behind Lung Cancer Surgery

“…In patients with <8 mm NSCLC, surgical resection had a better prognosis than non-surgical treatment. However, the factors that should have been incorporated into the proper propensity-matched analysis, such as comorbidity, cardiopulmonary function, and performance status, were not available, and the actual superiority or inferiority should be investigated further in an ongoing randomised trial, particularly when comparing surgery and stereotactic body irradiation ( 4 ).…”

The influence of the COVID‐19 pandemic on lung cancer surgery in Queensland

“…4,12,13 Across all ages, survival was demonstrated to be superior amongst surgical patients compared to alternate or no treatment. [14][15][16][17] Surgical excision can be considered at all stages of LC, however the prognostic benefit is most pronounced in Stage I and II. Surgery in Stage IIIA onward is usually preformed as part of a multi-modal treatment plan.…”

Development and validation of an epithelial–mesenchymal transition-related gene signature for predicting prognosis

“…Currently, there are many therapeutic methods for LUAD, including curative resection, radiotherapy, chemo-therapy, targeted therapy, and immunotherapy. Although the therapeutic prognosis of lung cancer has improved significantly because of advances in technology and selection strategies, the prognosis for lung cancer patients remains poor, as 70%-80% of patients are diagnosed in advanced stages[ 4 , 5 ]. In modern clinical oncology, histopathology is commonly effective in predicting the prognosis of lung cancer patients; however, its value is limited, as individual distinctions in patients with the identical pathological characteristics result in different conclusions.…”