The Role of Surgery for Stage 0 Adenocarcinoma In Situ of the Lung: A National Analysis

Objectives: Overall survival (OS) of patients with stage 0 adenocarcinoma in situ (AIS) of the lung is not well characterized in the U.S. Specifically, there are a lack of data regarding the OS of patients with stage 0 AIS who do not receive treatment. We compared OS among stage 0 AIS patients who received surgery and those who received no treatment. Methods: OS of patients with stage 0 (TIS, N0, M0) AIS of the lung who received surgery versus no treatment from 2010 to 2018 in the National Cancer Data Base was evaluated using multivariable Cox proportional hazards modeling and propensity score-matched analysis. Predictors of surgery were evaluated using multivariable logistic regression. Survival outcomes based on surgical approach were evaluated in a propensity score-matched subgroup analysis. Results: Of the 897 patients who were diagnosed with stage 0 AIS, 716 (79.8%) underwent surgical resection. A propensity score-matched analysis of 134 patients who received no treatment and 134 patients who underwent surgery showed that the surgical group had a significantly improved OS at five-years 85.8% (95% CI: 74.2-92.4%) compared to the group who received no treatment 62.8% (95% CI: 50.1-72.7%) (log-rank, p < 0.0001). Subgroup propensity score-matched analysis showed no significant differences in OS at five-years in the surgical group consisting of 201 patients who underwent a wedge resection 90.8% (95% CI: 83.8-94.8) compared to 201 patients who underwent a lobectomy 94.9% (95% CI: 89.9-97.4%) (log-rank, p = 0.19). Conclusions: In this national analysis, stage 0 AIS patients who underwent surgery had significantly better OS when compared to patients who did not receive treatment.