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Sublobar Resection in Early Non-Small Cell Lung Cancer With Epidermal Growth Factor Receptor Mutant
Takahiro Mimae1, Yoshihiro Miyata1, Norifumi Tsubokawa1
1Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
Background:
Lobectomy is a standard surgical procedure for peripherally located early-stage non-small cell lung cancers (NSCLCs) measuring 2 to 4 cm. However, it is unclear whether sublobar resections, such as wedge resection and segmentectomy, are effective in treating tumors with driver mutations in the epidermal growth factor receptor (EGFR).
Methods:
We analyzed the clinicopathologic findings and surgical outcomes of 1395 patients with radiologically solid-dominant NSCLC measuring 2 to 4 cm, without clinical lymph node involvement, who underwent complete resection between 2010 and 2020. The patients, who underwent sublobar resections (n = 231) or lobectomy (n = 1164), were categorized by their EGFR mutation status and the surgical procedures performed. The follow-up was conducted for a median of 45.3 months.
Results:
The 5-year overall survival (OS) rates after sublobar resections (n = 39) were comparable to those after lobectomy (n = 359) in patients with EGFR mutation-positive tumors (80.5% [95% CI, 51.3%-93.2%] vs 88.8% [95% CI, 84.1%-92.1%], respectively; P = .16). Multivariable Cox regression analysis of OS revealed that the surgical procedure was an independent prognostic predictor in the entire cohort (hazard ratio, 0.6; 95% CI, 0.4-1.0; P = .028), but it was not an independent prognostic predictor in patients with EGFR-mutated tumors (hazard ratio, 0.6; 95% CI, 0.2-1.7; P = .32).
Conclusions:
Sublobar resection with a secure surgical margin could be a viable option for appropriately selected patients with peripheral early-stage NSCLC tumors measuring 2 to 4 cm and harboring EGFR mutations, because it provides comparable OS to that of lobectomy.
Insights
Sublobar resections offer comparable survival to lobectomy for early-stage non-small cell lung cancer (NSCLC) with EGFR mutations. This finding supports sublobar resection as a viable option for select NSCLC patients.
Area of Science:
- Thoracic Surgery
- Oncology
- Pulmonary Medicine
Background:
- Lobectomy is standard for early-stage non-small cell lung cancer (NSCLC) (2-4 cm).
- Efficacy of sublobar resections (wedge, segmentectomy) for EGFR-mutated NSCLC is uncertain.
Purpose of the Study:
- To compare surgical outcomes of sublobar resections versus lobectomy in NSCLC patients.
- To evaluate the impact of EGFR mutation status on treatment efficacy.
Main Methods:
- Analysis of 1395 patients with solid-dominant NSCLC (2-4 cm) undergoing complete resection (2010-2020).
- Comparison of sublobar resections (n=231) versus lobectomy (n=1164) based on EGFR mutation status.
- Median follow-up of 45.3 months.
Main Results:
- 5-year OS rates were comparable for sublobar resections and lobectomy in EGFR-mutated NSCLC (80.5% vs 88.8%, P=.16).
- Surgical procedure was an independent prognostic predictor in the overall cohort (HR=0.6, P=.028).
- Surgical procedure was NOT an independent predictor in EGFR-mutated NSCLC (HR=0.6, P=.32).
Conclusions:
- Sublobar resection with adequate margins is a viable option for selected peripheral early-stage NSCLC patients with EGFR mutations.
- Sublobar resection provides comparable overall survival to lobectomy in this patient group.
