title: Limited resection for the treatment of patients with stage IA lung cancer.
abstract: OBJECTIVE
  Lobectomy is the standard of care for stage IA lung cancer. Some small retrospective studies have suggested similar results after limited resection for tumors < or =2 cm in size. The objective of the study was to compare survival after lobectomy and limited resection among Medicare patients with lung cancer.
  
  
  METHODS
  Using the Surveillance, Epidemiology, and End Results registry, linked to Medicare records, we identified 1165 cases of stage I lung cancer < or =2 cm in size that underwent lobectomy or limited resection (segmentectomy or wedge resection). We used logistic regression to determine propensity scores for undergoing limited resection based on the patients' preoperative characteristics. Overall and lung cancer-specific survival of patients treated with lobectomy or limited resection was compared after adjusting for their propensity score.
  
  
  RESULTS
  Overall, 196 (17%) patients underwent limited resection. For the entire sample, the adjusted hazard ratio for all cause mortality (1.09; 95% confidence interval: 0.85-1.40) or lung cancer-specific death (hazard ratio: 1.39; 95% confidence interval: 0.97-2.01) for patients undergoing limited resection were not significantly different from those having lobectomy. Similarly, we found no significant differences in overall or lung cancer-specific survival for patients treated with limited resection compared with lobectomy when data was analyzed stratifying and matching patients by their propensity scores.
  
  
  CONCLUSIONS
  These results suggest that survival of patients >65 years of age undergoing limited resection or lobectomy for stage IA tumors < or =2 cm appears to be similar. Although these findings should be confirmed in prospective trials, our results suggest that limited resection may be an effective therapeutic alternative for these patients.
authors.affiliation: Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY, USA. juan.wisnivesky@mssm.edu
authors.forename: Juan P
authors.initials: JP
authors.lastname: Wisnivesky
authors.forename: Claudia I
authors.initials: CI
authors.lastname: Henschke
authors.forename: Scott
authors.initials: S
authors.lastname: Swanson
authors.forename: David F
authors.initials: DF
authors.lastname: Yankelevitz
authors.forename: Javier
authors.initials: J
authors.lastname: Zulueta
authors.forename: Sue
authors.initials: S
authors.lastname: Marcus
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Halm
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D016896:Treatment Outcome