title: Survival after Sublobar Resection for Early-Stage Lung Cancer: Methodological Obstacles in Comparing the Efficacy to Lobectomy.
abstract: BACKGROUND
  Surgery is the treatment of choice for early-stage lung cancer (LC). Although lobectomy (L) is the historic standard treatment, the issue of whether long-term outcomes of sublobar resection (SL) are comparable is still under debate. The objective of this study was to perform a review of the literature on 5-year survival rates after SL compared to L for patients with early-stage LC.
  
  
  METHODS
  A priori inclusion criteria were as follows: (1) observational studies, (2) L compared to SL for early-stage LC, (3) radiographic staging by computed tomography scan, and (4) 5-year survival reported. A Medline search through January 2015 resulted in 31 studies representing 23 distinct datasets. The absolute difference in 5-year survival was calculated and plotted for each study.
  
  
  RESULTS
  L was performed in 4564 patients and SL in 2287 patients. Of 19 studies reporting the reason for SL, 11 indicated that SL was performed because of comorbidities or impaired cardiopulmonary function. Four studies showed no difference in 5-year survival, 13 favored L, and six favored SL. One propensity score study favored L and the other favored SL. Of 20 studies reporting recurrence rate, 11 favored L and nine favored SL.
  
  
  CONCLUSIONS
  Studies comparing 5-year survival rates of SL to L are sufficiently heterogeneous to prevent carrying out traditional meta-analysis. SL survival is often similar to L when adjustments are made for age, comorbidities, or impaired cardiopulmonary function. New approaches are needed for the comparison of L to SL.
authors.affiliation: Thoracic Surgery Department, Icahn School of Medicine at Mount Sinai, New York, NY; Population Health Science and Policy Department, Icahn School of Medicine at Mount Sinai, New York, NY; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Taioli
authors.affiliation: Radiology Department, Mount Sinai Health System, Icahn School of Medicine, New York, NY.
authors.forename: Rowena
authors.initials: R
authors.lastname: Yip
authors.affiliation: Department of Statistics, Stanford University, Stanford, CA.
authors.forename: Ingram
authors.initials: I
authors.lastname: Olkin
authors.affiliation: Thoracic Surgery Department, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Andrea
authors.initials: A
authors.lastname: Wolf
authors.affiliation: Thoracic Surgery Department, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Daniel
authors.initials: D
authors.lastname: Nicastri
authors.affiliation: Radiology Department, Mount Sinai Health System, Icahn School of Medicine, New York, NY.
authors.forename: Claudia
authors.initials: C
authors.lastname: Henschke
authors.affiliation: Radiology Department, Mount Sinai Health System, Icahn School of Medicine, New York, NY.
authors.forename: David
authors.initials: D
authors.lastname: Yankelevitz
authors.affiliation: General Thoracic Surgery Division, General Thoracic Surgery Department, New York University Langone Medical Center, New York University School of Medicine, New York, NY.
authors.forename: Harvey
authors.initials: H
authors.lastname: Pass
authors.affiliation: Thoracic Surgery Department, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: raja.flores@mountsinai.org.
authors.forename: Raja M
authors.initials: RM
authors.lastname: Flores
mesh_terms: D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D015201:Meta-Analysis as Topic; D011013:Pneumonectomy / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Epidemiology; Outcome; Systematic review