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Sublobar resection for node-negative lung cancer 2-5 cm in size
Brendon M Stiles1, Jialin Mao1, Sebron Harrison1
1Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA.
Summary
Sublobar resection (SLR) for stage I non-small-cell lung cancer (NSCLC) tumors larger than 2 cm is associated with worse survival outcomes compared to lobectomy. SLR may be suitable for select high-risk patients with carefully staged tumors.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Pulmonary Medicine
Background:
- Sublobar resection (SLR) is an alternative surgical approach for early-stage non-small-cell lung cancer (NSCLC).
- Outcomes for SLR in patients with NSCLC tumors exceeding 2 cm remain incompletely understood.
- This study investigates the utilization and effectiveness of SLR for stage I NSCLC tumors measuring between 2 and 5 cm.
Purpose of the Study:
- To determine the utilization rate of SLR for stage I NSCLC tumors sized 2-5 cm.
- To compare survival outcomes between lobectomy and SLR in this patient cohort.
- To identify predictors of outcomes for patients undergoing SLR for stage I NSCLC.
Main Methods:
- Utilized the Surveillance, Epidemiology and End Results (SEER)-Medicare database for patients aged ≥66 years with stage I NSCLC (2-5 cm).
- Evaluated overall survival and cancer-specific survival comparing lobectomy versus SLR cohorts.
- Employed propensity score matching to control for patient characteristics and compare survival rates.
Main Results:
- SLR was performed in 15% of 4582 patients with 2-5 cm stage I NSCLC tumors (2007-2012).
- Patients undergoing SLR were older, had smaller tumors, and more comorbidities; they also had less extensive lymphadenectomy.
- SLR was associated with significantly higher all-cause and cancer-specific mortality rates compared to lobectomy, both before and after propensity score matching.
Conclusions:
- SLR appears inferior to lobectomy for stage I NSCLC tumors 2-5 cm, linked to less lymphadenectomy and worse survival.
- Despite poorer outcomes compared to lobectomy, the 3-year cancer-specific survival with SLR (76.5%) might be comparable to other localized treatments.
- SLR could be a viable option for carefully staged, high-risk patients with 2-5 cm, N0 NSCLC.
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