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Surgeons' preference sublobar resection for stage I NSCLC less than 3 cm
Chien-Sheng Huang1,2, Po-Kuei Hsu1, Chun-Ku Chen3
1Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
Thoracic Cancer
|February 11, 2020
Summary
For stage I non-small cell lung cancer (NSCLC) under 3 cm, carefully selected patients undergoing sublobar resection show survival outcomes comparable to standard lobectomy. This indicates sublobar resection is a viable option for specific NSCLC cases.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Pulmonary Medicine
Background:
- Standard treatment for stage I non-small cell lung cancer (NSCLC) often involves lobectomy.
- Sublobar resection is an alternative surgical approach, particularly for patients with smaller tumors or comorbidities.
- The comparative survival outcomes between lobectomy and surgeon's preference sublobar resection in early-stage NSCLC require further investigation.
Purpose of the Study:
- To compare disease-free survival (DFS) between standard lobectomy and surgeon's preference sublobar resection.
- To identify factors associated with DFS in patients with stage I NSCLC.
- To evaluate the efficacy of sublobar resection in carefully selected patients with stage I NSCLC <3 cm.
Main Methods:
- Retrospective review of medical records for 1064 patients with pathological stage I NSCLC who underwent pulmonary resection between 2006 and 2016.
- 1-1 propensity score-matching was used to compare DFS between lobectomy and surgeon's preference sublobar resection groups (n=119 per group).
- Multivariable Cox regression analysis was performed to identify DFS-associated factors.
Main Results:
- Five-year DFS rates were 88.7% for lobectomy, 71.0% for medically unfit sublobar resection, and 93.4% for surgeon's preference sublobar resection (P < 0.001).
- Propensity-matched analysis revealed no significant difference in five-year DFS between lobectomy and surgeon's preference sublobar resection (90.5% vs. 93.4%, P = 0.510).
- Radiological solid appearance, PL2 invasion, and angiolymphatic invasion were significantly associated with lower DFS.
Conclusions:
- Surgeon's preference sublobar resection offers comparable survival outcomes to lobectomy for carefully selected patients with stage I NSCLC <3 cm.
- Sublobar resection is an effective and applicable surgical option for specific cases of early-stage NSCLC.
- Tumor characteristics such as solid appearance and specific invasion patterns are critical factors influencing DFS.
