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Lobar or Sublobar Resection for Peripheral Stage IA Non-Small-Cell Lung Cancer
Nasser Altorki1, Xiaofei Wang1, David Kozono1
1From Weill Cornell Medicine, New York-Presbyterian Hospital (N.A., J.P.), Memorial Sloan Kettering Cancer Center (D.R.J.), and New York University Grossman School of Medicine (H.P.), New York, and SUNY Upstate Medical University, Syracuse (L.J.K.) - all in New York; the Alliance Statistics and Data Management Center and the Department of Biostatistics and Bioinformatics, Duke University (X.W.), and Duke Cancer Institute, Duke University Medical Center (T.E.S.) - both in Durham, NC; Alliance Protocol Operations Office (D.K., C.W.) and the University of Chicago Comprehensive Cancer Center (E.V.) - both in Chicago; University of Pittsburgh Medical Center, Pittsburgh (R.L.); Mayo Clinic, Rochester, MN (D.W.); Institut Universitaire de Cardiologie et Pneumologie de Québec, Quebec (M.C.), and Centre Hospitalier de l'Université de Montréal, Montreal (M.L.), QC, Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, BC (A.S.A.), and the University of Toronto, Toronto (K.Y.) - all in Canada; Johns Hopkins University, Baltimore (S.Y.); University of Colorado Hospital School of Medicine, Aurora (J.D.M.); Moffitt Cancer Center, Tampa, FL (R.K.); Hackensack Meridian Health System, Edison, NJ (T.B.); and Emory University School of Medicine, Atlanta (D.M.).
Sublobar resection is a viable alternative to lobectomy for early-stage non-small-cell lung cancer (NSCLC), demonstrating comparable disease-free and overall survival rates. This lung cancer surgery option also showed better pulmonary function post-operation.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Pulmonary Medicine
Background:
- Increased detection of small, peripheral non-small-cell lung cancer (NSCLC) has spurred interest in less invasive surgical options.
- Sublobar resection is being re-evaluated as an alternative to lobectomy for early-stage lung cancer.
Purpose of the Study:
- To compare the efficacy and safety of sublobar resection versus lobectomy for NSCLC.
- To determine if sublobar resection is non-inferior to lobectomy in terms of disease-free survival.
Main Methods:
- A multicenter, phase 3 noninferiority trial (CALGB 140503) was conducted.
- 697 patients with NSCLC (T1aN0, ≤2 cm) were randomized to sublobar or lobar resection.
- Disease-free survival was the primary endpoint, with overall survival and pulmonary function as secondary endpoints.
Main Results:
- Sublobar resection was non-inferior to lobectomy for disease-free survival (HR 1.01, 90% CI 0.83-1.24).
- Overall survival rates were similar between the two surgical groups (HR 0.95, 95% CI 0.72-1.26).
- Sublobar resection showed a slight advantage in pulmonary function (FEV1) at 6 months post-surgery.
Conclusions:
- For peripheral NSCLC patients with tumors ≤2 cm and node-negative disease, sublobar resection is not inferior to lobectomy.
- Both surgical approaches yield similar overall survival outcomes.
- Sublobar resection may offer benefits in preserving pulmonary function.
