The Effect of Tumor Size and Histologic Findings on Outcomes After Segmentectomy vs Lobectomy for Clinically Node-Negative Non-Small Cell Lung Cancer

Raman, Vignesh; Jawitz, Oliver K.; Voigt, Soraya L.; Rhodin, Kristen E.; D’Amico, Thomas A.; Harpole, David H.; Yang, Chi‐Fu Jeffrey; Tong, Betty C.

doi:10.1016/j.chest.2020.06.066

Cited by 31 publications

(28 citation statements)

References 24 publications

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“…After stratifying the patients by tumor size, they found that lobectomy was associated with more favorable CSS and OS for tumors measuring 21-30 mm, which is corroborated by the results of our study (10). A more recent National Cancer Database (NCDB) study that reviewed 143,040 patients with cT1-3N0M0 NSCLC concluded that the survival advantage offered by lobectomy over segmental resection in patients with ADC >10 mm and SCC >15 mm (both categories encompass the size of interest of 21-30 mm in our study) could be confirmed in multivariate Cox regression models and subgroup analyses (16). However, in a larger single-institution retrospective cohort study of 145 cases, Carr et al reported that there were no differences in mortality, recurrence, or CSS between the segmental resection group and the lobectomy group for confirmed T1bN0M0 (21-30 mm) NSCLC, staged according to the 7th edition of the TNM staging system (17).…”

Section: Discussionsupporting

confidence: 89%

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

Zhang

et al. 2021

Transl Lung Cancer Res

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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.

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Section: Discussionsupporting

confidence: 89%

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

Zhang

et al. 2021

Transl Lung Cancer Res

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“…In this issue of CHEST, Raman et al 12 investigated the interaction between tumor size, histology, and type of surgical resection (lobectomy or segmentectomy) in 143,040 patients from the National Cancer Database (NCDB) registry. Using a sound statistical approach, the authors reported a significant interaction in favor of lobectomy and suggested a benefit-yielding size limit of 10 mm for segmentectomies performed in adenocarcinomas and 15 mm in squamous cell carcinomas and large cell carcinomas.…”

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confidence: 99%

“…The study 12 represents real-world data in a large cohort, with 5% of the patients undergoing segmentectomy, and is aimed at improving the decision-making process regarding the extent of lung resection. Furthermore, the authors included only N0 disease, with the database staging being performed at the first point of clinician and patient contact.…”

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confidence: 99%

“…The article 12 advances the field by addressing an important question regarding the size threshold for NSCLCs suitable for a sublobar anatomic lung resection (segmentectomy) based on different histology types. One of the interesting findings in this article is that the survival differences between tumor sizes have not fully translated into the lepidic and papillary pattern adenocarcinomas, emphasizing the need for preoperative histologic subtyping to further enhance the multidisciplinary lung team decision process.…”

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confidence: 99%

“…One of the interesting findings in this article is that the survival differences between tumor sizes have not fully translated into the lepidic and papillary pattern adenocarcinomas, emphasizing the need for preoperative histologic subtyping to further enhance the multidisciplinary lung team decision process. The authors 12 discuss the differences between their study and the Surveillance, Epidemiology, and End Results (SEER) registry, with the benefits of the NCDB registry being the inclusion of a substantially larger proportion of patients diagnosed with lung cancer and the availability of detailed information on tumor staging and comorbidities. These data on comorbidities provided further insight into the comparison between segmentectomy and lobectomy.…”

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Comparing Outcomes of Segmentectomy and Lobectomy for Non-small Cell Lung Cancer

Roman

Nakas

2021

Chest

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Outcomes of sublobar resection vs lobectomy for invasive clinical stage T1N0 non‐small‐cell lung cancer: A propensity‐match analysis

et al. 2021

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Background The role of sub lobar resection (SLR; either segmentectomy or wedge resection) vs lobectomy (LBCT) for invasive clinical stage T1N0 non‐small‐cell‐lung‐cancer (NSCLC) has not been fully established yet. Aim We aimed to characterize the preoperative parameters leading to selecting SLR and compare the overall survival (OS) and disease‐free survival (DFS) of these two surgical approaches. Methods Clinical data on 162 patients (LBCT‐107; SLR‐55) were prospectively entered in our departmental database. Preoperative parameters associated with the performance of SLR were identified using univariate and multivariate cox regression analysis. The Kaplan‐Meier method was used to compute OS and DFS. Comparison between LBCT and SLR groups and 32 propensity‐matched groups was performed using Log‐rank test. Results Median follow‐up time for the LBCT and SLR groups was 4.76 (Inter‐quartile range [IQR] 2.96 to 8.23) and 3.38 (IQR 2.9 to 6.19) years respectively. OS and DFS rates were similar between the two groups in the entire cohort (OS‐LBCT vs SLR P = .853, DSF‐LBCT vs SLR P = .653) and after propensity matching (OS‐LBCT vs SLR P = .563 DSF‐LBCT vs SLR P = .632). Specifically, Two‐ and five‐year OS rates for LBCT and SLR were 90.6.% vs 92.7%, 71.8% vs 75.9% respectively. Independent predictors of selecting for SLR included older age (P < .001), reduced FEV1% (P = .026), smaller tumor size (P = .025), smaller invasive component (P = .021) and higher American Society of Anesthesiology scores (P = .014). Conclusions In 162 consecutive and 32 matched cases, SLR and lobar resection had similar overall and disease‐free survival rates. SLR may be considered as a reasonable oncological procedure in carefully selected T1N0 NSCLC patients that present with multiple comorbidities and relatively small tumors.

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The Effect of Tumor Size and Histologic Findings on Outcomes After Segmentectomy vs Lobectomy for Clinically Node-Negative Non-Small Cell Lung Cancer

Cited by 31 publications

References 24 publications

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

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

Comparing Outcomes of Segmentectomy and Lobectomy for Non-small Cell Lung Cancer

Outcomes of sublobar resection vs lobectomy for invasive clinical stage T1N0 non‐small‐cell lung cancer: A propensity‐match analysis

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