J Thorac Oncol. 2015 Sep 8. [Epub ahead of print]

Survival After Sublobar Resection vs. Lobectomy for Clinical Stage IA Lung Cancer: An Analysis from the National Cancer Data Base.

Khullar OV1, Liu Y, Gillespie T, Higgins KA, Ramalingam S, Lipscomb J, Fernandez FG.

Author information

• 11Division of Cardiothoracic Surgery, 2Biostatistics and Bioinformatics Shared Resource at Winship Cancer Institute, 3Rollins School of Public Health, 4Department of Hematology and Medical Oncology, 5Department of Surgery, 6Department of Radiation Oncology, 7Winship CancerInstitute, Emory University School of Medicine, Atlanta, GA.

Abstract

BACKGROUND:

Recent data have suggested possible oncologic equivalence of sublobar resection with lobectomy for early stage NSCLC.Our aim was to evaluate and compare short and long term survival for these surgical approaches.

METHODS:

This retrospective cohort study utilized the National Cancer Data Base. Patients undergoing lobectomy, segmentectomy,or wedge resection for preoperative clinical T1A N0 NSCLC from 2003-2011 were identified.Overall survival (OS) and 30-day mortality were analyzed using multivariable Cox proportional hazards models,logistic regression models,and propensity score matching.Further analysis of survival stratified by tumor size, facility type, number of lymph nodes examined, and surgical margins was performed.

RESULTS:

A total of 13,606 patients were identified. After propensity score matching, 987 patients remained in each group. Both segmentectomy and wedge resection were associated with significantly worse OS when compared with lobectomy (HR 1.70 and 1.45, respectively, both p < 0.001), with no difference in 30 day mortality. Median OS for lobectomy, segmentectomy, and wedge resection were 100, 74, and 68 months, respectively (p < 0.001). Finally, sublobar resection was associated with increased likelihood of positive surgical margins, lower likelihood of having more than 3 lymph nodes examined, and significantly lower rates of nodal upstaging.

CONCLUSION:

In this large national-level, clinically diverse sample of clinical T1ANSCLC patients, wedge and segmental resectionswere shown to have significantly worse OS compared tolobectomy.Further patients undergoing sublobar resection were more likely to have inadequate lymphadenectomy and positive margins. Ongoingprospective study taking into account LN upstaging and margin status is still needed.