Non-lung cancer mortality after lung cancer resection: associations with lobectomy and patient characteristics

In the JCOG0802 study, segmentectomy demonstrated higher overall survival than did lobectomy, possibly due to a lower incidence of non-lung cancer death. However, the underlying mechanisms remain unclear. This study investigated the cumulative incidence and factors associated with non-lung cancer death in patients with lung cancer who underwent curative resection.

In this single-center retrospective study, data from 1020 patients with stage 0-III lung cancer who underwent resection with lobectomy or segmentectomy between 2005 and 2023 were analyzed. Competing risk models (Fine and Gray) were used to estimate the cumulative incidence of non-lung cancer death and compare curves across clinicopathological factors.

Among 1020 patients, 135 died from non-lung cancer causes. With lung cancer death treated as a competing event, the 10-year cumulative incidence of non-lung cancer death after resection was 18.6%. Multivariable analysis identified older age, comorbidity, low body mass index (BMI), and lobectomy as factors associated with a higher subdistribution hazard of non-lung cancer death. In an exploratory analysis of patients aged ≥ 71 years, older age, smoking history, low BMI, and lobectomy were associated with a higher cumulative incidence of non-lung cancer death in univariable analysis. No statistically significant interaction was observed between age and surgical procedure (P for interaction = 0.079).

This study investigated the cumulative incidence of and risk factors for non-lung cancer death after lung cancer surgery. These findings suggest that patient characteristics should be considered when selecting the extent of lung resection.