Survival After Sublobar Resection versus Lobectomy for Clinical Stage IA Lung Cancer: An Analysis from the National Cancer Data Base.
BACKGROUND
Recent data have suggested possible oncologic equivalence of sublobar resection with lobectomy for early-stage non-small-cell lung cancer (NSCLC). Our aim was to evaluate and compare short-term and long-term survival for these surgical approaches.


METHODS
This retrospective cohort study utilized the National Cancer Data Base. Patients undergoing lobectomy, segmentectomy, or wedge resection for preoperative clinical T1A N0 NSCLC from 2003 to 2011 were identified. Overall survival (OS) and 30-day mortality were analyzed using multivariable Cox proportional hazards models, logistic regression models, and propensity score matching. Further analysis of survival stratified by tumor size, facility type, number of lymph nodes (LNs) examined, and surgical margins was performed.


RESULTS
A total of 13,606 patients were identified. After propensity score matching, 987 patients remained in each group. Both segmentectomy and wedge resection were associated with significantly worse OS when compared with lobectomy (hazard ratio: 1.70 and 1.45, respectively, both p < 0.001), with no difference in 30-day mortality. Median OS for lobectomy, segmentectomy, and wedge resection were 100, 74, and 68 months, respectively (p < 0.001). Finally, sublobar resection was associated with increased likelihood of positive surgical margins, lower likelihood of having more than three LNs examined, and significantly lower rates of nodal upstaging.


CONCLUSIONS
In this large national-level, clinically diverse sample of clinical T1A NSCLC patients, wedge and segmental resections were shown to have significantly worse OS compared with lobectomy. Further patients undergoing sublobar resection were more likely to have inadequate lymphadenectomy and positive margins. Ongoing prospective study taking into account LN upstaging and margin status is still needed.
*Division of Cardiothoracic Surgery, †Biostatistics and Bioinformatics Shared Resource at Winship Cancer Institute, ‡Rollins School of Public Health, §Department of Hematology and Medical Oncology, ‖Department of Surgery, ¶Department of Radiation Oncology, and #Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia.
Onkar V
OV
Khullar
Yuan
Y
Liu
Theresa
T
Gillespie
Kristin A
KA
Higgins
Suresh
S
Ramalingam
Joseph
J
Lipscomb
Felix G
FG
Fernandez
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D054547:National Cancer Institute (U.S.); D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000401:mortality*; D012189:Retrospective Studies; D016019:Survival Analysis; D014481:United States