title: Should males ever undergo wedge resection for stage 1 non-small-cell lung cancer? A propensity analysis.
abstract: OBJECTIVE
  Wedge resections are frequently performed for small peripheral lesions in patients unfit for a more extensive resection. We aimed to investigate whether patient sex and histology type are important factors determining survival in patients undergoing a wedge resection for stage I lung cancer.
  
  
  METHODS
  We retrospectively analysed a prospective thoracic database of patients (n = 2859) who had undergone potentially curative wedge resection for stage I non-small-cell lung cancer. Only patients with adenocarcinoma or squamous carcinoma were included (n = 540). We benchmarked our 5-year survival against the sixth International Association for the Study of Lung Cancer results. Kaplan-Meier, Cox multivariate regression analysis and propensity analysis were utilized to assess the effect of sex and histology on survival post-wedge resection with regard to long-term survival.
  
  
  RESULTS
  Cox regression of patients who had undergone wedge resection demonstrated that adenocarcinoma (odds ratio [OR]: 2.16, 95% confidence interval [CI]: 1.11-4.19), P = 0.02 was the only significant term determining long-term survival. Cox regression of male patients identified adenocarcinoma (OR: 3.29, 95% CI: 1.22-8.86), P = 0.02 as the only significant term determining long-term survival. Cox regression of female patients failed to identify any significant factors that determine long-term survival. Propensity matching based on gender identified that gender had no effect on survival, P = 0.46; however, histology was associated with a difference in survival, P = 0.02. This effect occurred in males, P = 0.02, but not females, P = 0.26. Propensity matching based on histology identified that gender had no effect on survival, P = 0.29; however, histology was associated with a difference in survival, P = 0.01. This effect occurred in males, P = 0.01, but not females, P = 0.26. Differing life expectancy between males and females was adjusted for by the use of the Framingham-predicted life expectancy.
  
  
  CONCLUSIONS
  Long-term survival of patients with stage I non-small-cell lung cancer who undergo a wedge resection is affected by gender and histological type. Male patients undergoing wedge resections for adenocarcinoma have outcomes inferior to those of patients with squamous carcinoma. Histology type does not affect survival in female patients undergoing wedge resections.
authors.affiliation: Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Mediratta
authors.affiliation: Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Shackcloth
authors.affiliation: Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Page
authors.affiliation: Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Woolley
authors.affiliation: Liverpool Heart and Chest Hospital, Liverpool, UK.
authors.forename: Julius
authors.initials: J
authors.lastname: Asante-Siaw
authors.affiliation: Liverpool Heart and Chest Hospital, Liverpool, UK mpoullis@hotmail.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Poullis
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods / Q000401:mortality*; D057216:Propensity Score; D012189:Retrospective Studies
keywords: Lung cancer; Outcome; Surgical treatment; Wedge