title: Sublobar Resection for Clinical Stage IA Non-small-cell Lung Cancer in the United States.
abstract: BACKGROUND
  This study evaluated the use of lobectomy and sublobar resection for clinical stage IA non-small-cell lung cancer (NSCLC) in the National Cancer Data Base (NCDB).
  
  
  METHODS
  The NCDB from 2003 to 2011 was analyzed to determine factors associated with the use of a sublobar resection versus a lobectomy for the treatment of clinical stage IA NSCLC. Overall survival was assessed using the Kaplan-Meier method and Cox proportional hazard modeling.
  
  
  RESULTS
  Among 39,403 patients included for analysis, 29,736 (75.5%) received a lobectomy and 9667 (24.5%) received a sublobar resection: 84.7% wedge resection (n = 8192) and 15.3% segmental resection (n = 1475). Lymph node evaluation was not performed in 2788 (28.8%) of sublobar resection patients, and 7298 (75.5%) of sublobar resections were for tumors ≤ 2 cm. After multivariable logistic regression, older age, higher Charlson-Deyo comorbidity scores, smaller tumor size, and treatment at lower-volume institutions were associated with sublobar resection (all P < .001). Overall, lobectomy was associated with significantly improved 5-year survival compared to sublobar resection (66.2% vs. 51.2%; P < .001, adjusted hazard ratio 0.66; P < .001). However among sublobar resection patients, nodal sampling was associated with significantly better 5-year survival (58.2% vs. 46.4%; P < .001).
  
  
  CONCLUSIONS
  Despite adjustment for patient and tumor related characteristics, a sublobar resection is associated with significantly reduced long-term survival compared to a formal surgical lobectomy among patients with NSCLC, even for stage 1A tumors. For patients who cannot tolerate lobectomy and who are treated with sublobar resection, lymph node evaluation is essential to help guide further treatment.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Speicher
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC.
authors.forename: Lin
authors.initials: L
authors.lastname: Gu
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Gulack
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC.
authors.forename: Xiaofei
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: D'Amico
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Hartwig
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC; Department of Cardiothoracic Surgery, Stanford University, Stanford, CA. Electronic address: berry037@stanford.edu.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Berry
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States
keywords: Lobectomy; Lung cancer; NSCLC; Stage IA; Sublobar resection