title: Sublobar resection is equivalent to lobectomy for clinical stage 1A lung cancer in solid nodules.
abstract: OBJECTIVE
  A single randomized trial established lobectomy as the standard of care for the surgical treatment of early-stage non-small cell lung cancer. Recent advances in imaging/staging modalities and detection of smaller tumors have once again rekindled interest in sublobar resection for early-stage disease. The objective of this study was to compare lung cancer survival in patients with non-small cell lung cancer with a diameter of 30 mm or less with clinical stage 1 disease who underwent lobectomy or sublobar resection.
  
  
  METHODS
  We identified 347 patients diagnosed with lung cancer who underwent lobectomy (n = 294) or sublobar resection (n = 53) for non-small cell lung cancer manifesting as a solid nodule in the International Early Lung Cancer Action Program from 1993 to 2011. Differences in the distribution of the presurgical covariates between sublobar resection and lobectomy were assessed using unadjusted P values determined by logistic regression analysis. Propensity scoring was performed using the same covariates. Differences in the distribution of the same covariates between sublobar resection and lobectomy were assessed using adjusted P values determined by logistic regression analysis with adjustment for the propensity scores. Lung cancer-specific survival was determined by the Kaplan-Meier method. Cox survival regression analysis was used to compare sublobar resection with lobectomy, adjusted for the propensity scores, surgical, and pathology findings, when adjusted and stratified by propensity quintiles.
  
  
  RESULTS
  Among 347 patients, 10-year Kaplan-Meier for 53 patients treated by sublobar resection compared with 294 patients treated by lobectomy was 85% (95% confidence interval, 80-91) versus 86% (confidence interval, 75-96) (P = .86). Cox survival analysis showed no significant difference between sublobar resection and lobectomy when adjusted for propensity scores or when using propensity quintiles (P = .62 and P = .79, respectively). For those with cancers 20 mm or less in diameter, the 10-year rates were 88% (95% confidence interval, 82-93) versus 84% (95% confidence interval, 73-96) (P = .45), and Cox survival analysis showed no significant difference between sublobar resection and lobectomy using either approach (P = .42 and P = .52, respectively).
  
  
  CONCLUSIONS
  Sublobar resection and lobectomy have equivalent survival for patients with clinical stage IA non-small cell lung cancer in the context of computed tomography screening for lung cancer.
authors.affiliation: NY Presbyterian Hospital/Weill Cornell Medical College, New York, NY.
authors.forename: Nasser K
authors.initials: NK
authors.lastname: Altorki
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Rowena
authors.initials: R
authors.lastname: Yip
authors.affiliation: Azumi General Hospital, Nagano, Japan.
authors.forename: Takaomi
authors.initials: T
authors.lastname: Hanaoka
authors.affiliation: Helen F. Graham Cancer Center, Newark, Del.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bauer
authors.affiliation: Swedish Medical Center, Seattle, Wash.
authors.forename: Ralph
authors.initials: R
authors.lastname: Aye
authors.affiliation: Upstate Medical Center, Syracuse, NY.
authors.forename: Leslie
authors.initials: L
authors.lastname: Kohman
authors.affiliation: Dorothy E. Schneider Cancer Center, Mills-Peninsula Health Services, San Mateo, Calif.
authors.forename: Barry
authors.initials: B
authors.lastname: Sheppard
authors.affiliation: Jackson Memorial Hospital, University of Miami, Miami, Fla.
authors.forename: Richard
authors.initials: R
authors.lastname: Thurer
authors.affiliation: South Nassau Communities Hospital, Long Island, NY.
authors.forename: Shahriyour
authors.initials: S
authors.lastname: Andaz
authors.affiliation: Georgia Institute for Lung Cancer Research, Atlanta, Ga.
authors.forename: Michael
authors.initials: M
authors.lastname: Smith
authors.affiliation: Wellstar Health System, Marietta, Ga.
authors.forename: William
authors.initials: W
authors.lastname: Mayfield
authors.affiliation: City of Hope National Medical Center, Duarte, Calif.
authors.forename: Fred
authors.initials: F
authors.lastname: Grannis
authors.affiliation: The Valley Hospital Cancer Center, Paramus, NJ.
authors.forename: Robert
authors.initials: R
authors.lastname: Korst
authors.affiliation: New York University Medical Center, New York, NY.
authors.forename: Harvey
authors.initials: H
authors.lastname: Pass
authors.affiliation: John Muir Cancer Institute, Concord, Calif.
authors.forename: Michaela
authors.initials: M
authors.lastname: Straznicka
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Raja
authors.initials: R
authors.lastname: Flores
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: Claudia.Henschke@mountsinai.org.
authors.forename: Claudia I
authors.initials: CI
authors.lastname: Henschke
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D011237:Predictive Value of Tests; D057216:Propensity Score; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: 10; 10.4; 36.1; CAC; CI; CT; HR; I-ELCAP; International Early Lung Cancer Action Program; LCSG; LR; Lung Cancer Study Group; NSCLC; PET; SLR; computed tomography; confidence interval; coronary artery calcification; hazard ratio; lobar resection; non–small cell lung cancer; positron emission tomography; sublobar resection