Surgical modality for stage IA non-small cell lung cancer among the elderly: analysis of the Surveillance, Epidemiology, and End Results database

Abstract

Background: The appropriate surgical modality for early-stage non-small cell lung cancer (NSCLC) among the elderly remains controversial; identifying appropriate modalities will be helpful in clinical practice. Methods: It's a cohort study and we explored the Surveillance, Epidemiology, and End Results (SEER) database for identifying patients aged ≥70 years with pathologic stage IA NSCLC. Three types of surgeries were compared (lobectomy, segmentectomy, and wedge resection) via survival and stratification analyses.Results: Overall, 6,197 patients were enrolled. Among patients aged ≥76 years with tumor diameters ≤1 cm, significant differences in survival were noted for segmentectomy vs. lobectomy [hazard ratio (HR) =0.294, P=0.007] and wedge resection vs. lobectomy (HR =0.548, P=0.017) but not in those with tumors diameters >1 cm. Among patients aged 70-75 years with tumor diameters >1-2 cm, significant differences in survival were observed for segmentectomy vs. lobectomy (HR =0.671, P=0.037) and segmentectomy vs. wedge resection (HR =0.556, P=0.003) and for wedge resection vs. lobectomy (HR =1.283, P=0.003) among those with tumor diameters >2-3 cm but not in those with tumor diameters ≤1 cm. Conclusions: Both age and tumor size should be considered when selecting the surgical modality.Lobectomy is not recommended for lesions ≤1 cm among patients aged ≥76 years. Segmentectomy was associated with superior prognosis for tumor diameters >1-2 cm and survival favored lobectomy rather than wedge resection for NSCLCs >2-3 cm among patients aged 70-75 years. Surgeons could rely on personal experience to determine the appropriate surgical modality for NSCLCs >1 cm among patients aged ≥76 years and NSCLCs ≤1 cm among patients aged 70-75 years.

Segmentectomy and Wedge Resection for Elderly Patients with Stage I Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

“…Regarding patient characteristics, the sublobar resection groups showed im pulmonary function and increased chronic obstructive pulmonary diseases compa the lobectomy group (Table 1). The database analysis of SEER demonstrated mo vanced age in sublobar resection groups [3], but this was not commonly reported in studies. Regarding the disease characteristics, the tumor was larger in the lobe group than in the sublobar groups, with significant differences being reported in si ies [3,4,14,23,31,33].…”

“…The database analysis of SEER demonstrated mo vanced age in sublobar resection groups [3], but this was not commonly reported in studies. Regarding the disease characteristics, the tumor was larger in the lobe group than in the sublobar groups, with significant differences being reported in si ies [3,4,14,23,31,33]. The sublobar resection groups were also reported to have less node dissection [12,24,31].…”

“…The review of title and abstract excluded 484 papers. After evaluating the full texts, 4 database studies [3][4][5], 11 and 16 cohort studies [12][13][14][22][23][24][25][26][27][28][29][30][31][32][33][34] were included. The cohort studies included 3140 participants with 2009 lobectomies and 1131 sublobar resections.…”

“…Anatomic lobectomy with hilar and mediastinal lymph node dissection has been listed as the standard treatment for clinical stage I nonsmall-cell lung cancers (NSCLCs) [2]. Sublobar resections, including segmentectomy and wedge resection, are currently performed for early-stage peripheral tumors or cases of impaired cardiopulmonary function [3,4]. The merits of sublobar resections are mainly reducing perioperative morbidities and preserving postoperative pulmonary function [5,6].…”

Do Older Patients with Stage IB Non-Small-Cell Lung Cancer Obtain Survival Benefit from Surgery? A Propensity Score Matching Study Based on the SEER Database

“…The Surveillance, Epidemiology, and End Results (SEER) database is currently the largest oncology clinical database in the world and an ideal data pool for global oncology research [11]. However, previous studies based on the SEER database had some limitations, such as inconsistent criteria for tumor staging and bias of baseline characteristics of patients between speci c groups [12,13]. These limitations affected the comparative e ciency of the retrospective studies.…”