title: Temporal trends in outcomes following sublobar and lobar resections for small (≤ 2 cm) non-small cell lung cancers--a Surveillance Epidemiology End Results database analysis.
abstract: BACKGROUND
  Since the randomized, controlled study that favored lobectomy for resection of stage I non-small cell lung cancers (NSCLCs) by the Lung Cancer Study Group, there have been improvements in staging. The liberal use of computed tomography also may have altered the types of early lung cancer diagnosed. Studies published since then have drawn contradictory conclusions on the benefit of lobectomy over sublobar resections for early-stage NSCLC. We examined the Surveillance Epidemiology End Results database to test our hypothesis that the relationship between extent of resection and outcome has changed since the Lung Cancer Study Group study was published.
  
  
  METHODS
  We examined stage I NSCLCs ≤ 2 cm in size over three periods: 1988-1998 (Early), 1999-2004 (Intermediate), and 2005-2008 (Late). For each period, we assessed overall and disease-specific survivals and their associations with the extents of resection, by univariate and multivariate analyses. Sublobar resections in the Early group could not be categorized into segmentectomies and wedge resections because these were not coded separately.
  
  
  RESULTS
  The proportion of NSCLCs ≤ 2 cm increased from 0.98% in 1988 to 2.2% in 2008. Multivariate analyses showed that sublobar resection was inferior to lobectomy in the Early period (hazard ratio [HR], 1.41; 95% confidence interval [CI], 1.21-1.65). This effect decreased in the Intermediate period, in which segmentectomies but not wedge resections were equivalent to lobectomies (wedge versus lobectomy HR, 1.19; 95% CI, 1.01-1.41; segmentectomy versus lobectomy HR, 1.04; 95% CI, 0.8-1.36). The difference disappeared in the Late period, when both wedge resections and segmentectomies were equivalent to lobectomy (wedge versus lobectomy HR, 1.09; 95% CI, 0.79-1.5; segmentectomy versus lobectomy HR, 0.83; 95% CI, 0.47-1.45). Trends for both overall survival and disease-specific survival were identical.
  
  
  CONCLUSIONS
  The survival benefit of lobectomy over sublobar resection decreased over the past 2 decades with no discernible difference in the most contemporary cases. These results support reevaluation of lobectomy as the standard of care for small (≤ 2-cm) NSCLCs.
authors.affiliation: Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York 14263, USA. sai.yendamuri@roswellpark.org
authors.forename: Sai
authors.initials: S
authors.lastname: Yendamuri
authors.forename: Rohit
authors.initials: R
authors.lastname: Sharma
authors.forename: Michael
authors.initials: M
authors.lastname: Demmy
authors.forename: Adrienne
authors.initials: A
authors.lastname: Groman
authors.forename: Mark
authors.initials: M
authors.lastname: Hennon
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Dexter
authors.forename: Chukwumere
authors.initials: C
authors.lastname: Nwogu
authors.forename: Austin
authors.initials: A
authors.lastname: Miller
authors.forename: Todd
authors.initials: T
authors.lastname: Demmy
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008482:Mediastinum / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D018426:SEER Program; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology