title: Limited Resection Versus Lobectomy for Older Patients With Early-Stage Lung Cancer: Impact of Histology.
abstract: OBJECTIVE
  Limited resection has been increasingly used in older patients with stage IA lung cancer. However, the equivalency of limited resection versus lobectomy according to histology is unknown.
  
  
  METHODS
  We identified patients older than 65 years with stage IA invasive adenocarcinoma or squamous cell carcinoma ≤ 2 cm who were treated with limited resection (wedge or segmentectomy) or lobectomy in the Surveillance, Epidemiology, and End Results-Medicare database. We estimated propensity scores that predicted the use of limited resection and compared survival of patients treated with limited resection versus lobectomy. Treatments were considered equivalent if the upper 95th percentile of the hazard ratio (HR) for limited resection was ≤ 1.25.
  
  
  RESULTS
  Overall, 27% of 2,008 patients with adenocarcinoma and 32% of 1,139 patients with squamous cell carcinoma underwent limited resection. Survival analyses, adjusted for propensity score by using inverse probability weighting, showed that limited resection was not equivalent to lobectomy in patients with adenocarcinoma (HR, 1.21; upper 95% CI,1.34) or squamous cell carcinoma (HR, 1.21; upper 95% CI, 1.39). Although patients with adenocarcinomas treated with segmentectomy had equivalent survival rates to those treated with lobectomy (HR, 0.97; upper 95% CI, 1.07), outcomes of those treated with wedge resection (HR, 1.29; upper 95% CI, 1.42) did not. Among patients with squamous cell carcinoma, neither wedge resection (HR, 1.34; upper 95% CI, 1.53) nor segmentectomy (HR, 1.19; upper 95% CI, 1.36) were equivalent to lobectomy.
  
  
  CONCLUSIONS
  We found generally that limited resection is not equivalent to lobectomy in older patients with invasive non-small-cell lung cancer ≤ 2 cm in size, although segmentectomy may be equivalent in patients with adenocarcinoma.
authors.affiliation: Rajwanth R. Veluswamy, Nicole Ezer, Grace Mhango, Emily Goodman, Charles A. Powell, Mary B. Beasley, and Juan P. Wisnivesky, Icahn School of Medicine at Mount Sinai; Alfred I. Neugut, Columbia University, New York, NY; Nicole Ezer, McGill University, Montreal, Quebec, Canada; Marcelo Bonomi, Wake Forest School of Medicine, Winston-Salem, NC; and Scott Swanson, Brigham and Women's Hospital, Boston, MA. rajwanth.veluswamy@mountsinai.org.
authors.forename: Rajwanth R
authors.initials: RR
authors.lastname: Veluswamy
authors.affiliation: Rajwanth R. Veluswamy, Nicole Ezer, Grace Mhango, Emily Goodman, Charles A. Powell, Mary B. Beasley, and Juan P. Wisnivesky, Icahn School of Medicine at Mount Sinai; Alfred I. Neugut, Columbia University, New York, NY; Nicole Ezer, McGill University, Montreal, Quebec, Canada; Marcelo Bonomi, Wake Forest School of Medicine, Winston-Salem, NC; and Scott Swanson, Brigham and Women's Hospital, Boston, MA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Ezer
authors.affiliation: Rajwanth R. Veluswamy, Nicole Ezer, Grace Mhango, Emily Goodman, Charles A. Powell, Mary B. Beasley, and Juan P. Wisnivesky, Icahn School of Medicine at Mount Sinai; Alfred I. Neugut, Columbia University, New York, NY; Nicole Ezer, McGill University, Montreal, Quebec, Canada; Marcelo Bonomi, Wake Forest School of Medicine, Winston-Salem, NC; and Scott Swanson, Brigham and Women's Hospital, Boston, MA.
authors.forename: Grace
authors.initials: G
authors.lastname: Mhango
authors.affiliation: Rajwanth R. Veluswamy, Nicole Ezer, Grace Mhango, Emily Goodman, Charles A. Powell, Mary B. Beasley, and Juan P. Wisnivesky, Icahn School of Medicine at Mount Sinai; Alfred I. Neugut, Columbia University, New York, NY; Nicole Ezer, McGill University, Montreal, Quebec, Canada; Marcelo Bonomi, Wake Forest School of Medicine, Winston-Salem, NC; and Scott Swanson, Brigham and Women's Hospital, Boston, MA.
authors.forename: Emily
authors.initials: E
authors.lastname: Goodman
authors.affiliation: Rajwanth R. Veluswamy, Nicole Ezer, Grace Mhango, Emily Goodman, Charles A. Powell, Mary B. Beasley, and Juan P. Wisnivesky, Icahn School of Medicine at Mount Sinai; Alfred I. Neugut, Columbia University, New York, NY; Nicole Ezer, McGill University, Montreal, Quebec, Canada; Marcelo Bonomi, Wake Forest School of Medicine, Winston-Salem, NC; and Scott Swanson, Brigham and Women's Hospital, Boston, MA.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Bonomi
authors.affiliation: Rajwanth R. Veluswamy, Nicole Ezer, Grace Mhango, Emily Goodman, Charles A. Powell, Mary B. Beasley, and Juan P. Wisnivesky, Icahn School of Medicine at Mount Sinai; Alfred I. Neugut, Columbia University, New York, NY; Nicole Ezer, McGill University, Montreal, Quebec, Canada; Marcelo Bonomi, Wake Forest School of Medicine, Winston-Salem, NC; and Scott Swanson, Brigham and Women's Hospital, Boston, MA.
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.affiliation: Rajwanth R. Veluswamy, Nicole Ezer, Grace Mhango, Emily Goodman, Charles A. Powell, Mary B. Beasley, and Juan P. Wisnivesky, Icahn School of Medicine at Mount Sinai; Alfred I. Neugut, Columbia University, New York, NY; Nicole Ezer, McGill University, Montreal, Quebec, Canada; Marcelo Bonomi, Wake Forest School of Medicine, Winston-Salem, NC; and Scott Swanson, Brigham and Women's Hospital, Boston, MA.
authors.forename: Scott
authors.initials: S
authors.lastname: Swanson
authors.affiliation: Rajwanth R. Veluswamy, Nicole Ezer, Grace Mhango, Emily Goodman, Charles A. Powell, Mary B. Beasley, and Juan P. Wisnivesky, Icahn School of Medicine at Mount Sinai; Alfred I. Neugut, Columbia University, New York, NY; Nicole Ezer, McGill University, Montreal, Quebec, Canada; Marcelo Bonomi, Wake Forest School of Medicine, Winston-Salem, NC; and Scott Swanson, Brigham and Women's Hospital, Boston, MA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Powell
authors.affiliation: Rajwanth R. Veluswamy, Nicole Ezer, Grace Mhango, Emily Goodman, Charles A. Powell, Mary B. Beasley, and Juan P. Wisnivesky, Icahn School of Medicine at Mount Sinai; Alfred I. Neugut, Columbia University, New York, NY; Nicole Ezer, McGill University, Montreal, Quebec, Canada; Marcelo Bonomi, Wake Forest School of Medicine, Winston-Salem, NC; and Scott Swanson, Brigham and Women's Hospital, Boston, MA.
authors.forename: Mary B
authors.initials: MB
authors.lastname: Beasley
authors.affiliation: Rajwanth R. Veluswamy, Nicole Ezer, Grace Mhango, Emily Goodman, Charles A. Powell, Mary B. Beasley, and Juan P. Wisnivesky, Icahn School of Medicine at Mount Sinai; Alfred I. Neugut, Columbia University, New York, NY; Nicole Ezer, McGill University, Montreal, Quebec, Canada; Marcelo Bonomi, Wake Forest School of Medicine, Winston-Salem, NC; and Scott Swanson, Brigham and Women's Hospital, Boston, MA.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Wisnivesky
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000601:surgery*; D000077192:Adenocarcinoma of Lung; D000367:Age Factors; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods; D018426:SEER Program; D014481:United States / Q000453:epidemiology