title: Recurrence and survival outcomes after anatomic segmentectomy versus lobectomy for clinical stage I non-small-cell lung cancer: a propensity-matched analysis.
abstract: OBJECTIVE
  Although anatomic segmentectomy has been considered a compromised procedure by many surgeons, recent retrospective, single-institution series have demonstrated tumor recurrence and patient survival rates that approximate those achieved by lobectomy. The primary objective of this study was to use propensity score matching to compare outcomes after these anatomic resection approaches for stage I non-small-cell lung cancer.
  
  
  METHODS
  A retrospective data set including 392 segmentectomy patients and 800 lobectomy patients was used to identify matched segmentectomy and lobectomy cohorts (n = 312 patients per group) using a propensity score matching algorithm that accounted for confounding effects of preoperative patient variables. Primary outcome variables included freedom from recurrence and overall survival. Factors affecting survival were assessed by Cox regression analysis and Kaplan-Meier estimates.
  
  
  RESULTS
  Perioperative mortality was 1.2% in the segmentectomy group and 2.5% in the lobectomy group (P = .38). At a mean follow-up of 5.4 years, comparing segmentectomy with lobectomy, no differences were noted in locoregional (5.5% v 5.1%, respectively; P = 1.00), distant (14.8% v 11.6%, respectively; P = .29), or overall recurrence rates (20.2% v 16.7%, respectively; P = .30). Furthermore, when comparing segmentectomy with lobectomy, no significant differences were noted in 5-year freedom from recurrence (70% v 71%, respectively; P = .467) or 5-year survival (54% v 60%, respectively; P = .258). Segmentectomy was not found to be an independent predictor of recurrence (hazard ratio, 1.11; 95% CI, 0.87 to 1.40) or overall survival (hazard ratio, 1.17; 95% CI, 0.89 to 1.52).
  
  
  CONCLUSIONS
  In this large propensity-matched comparison, lobectomy was associated with modestly increased freedom from recurrence and overall survival, but the differences were not statistically significant. These results will need further validation by prospective, randomized trials (eg, Cancer and Leukemia Group B 140503 trial).
authors: Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia. landreneaurj@upmc.edu.
authors: Rodney J
authors: RJ
authors: Landreneau
authors: Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia.
authors: Daniel P
authors: DP
authors: Normolle
authors: Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia.
authors: Neil A
authors: NA
authors: Christie
authors: Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia.
authors: Omar
authors: O
authors: Awais
authors: Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia.
authors: Joseph J
authors: JJ
authors: Wizorek
authors: Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia.
authors: Ghulam
authors: G
authors: Abbas
authors: Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia.
authors: Arjun
authors: A
authors: Pennathur
authors: Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia.
authors: Manisha
authors: M
authors: Shende
authors: Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia.
authors: Benny
authors: B
authors: Weksler
authors: Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia.
authors: James D
authors: JD
authors: Luketich
authors: Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia.
authors: Matthew J
authors: MJ
authors: Schuchert
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery* / Q000628:therapy*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome