Extent of lymphadenectomy is associated with oncological efficacy of sublobar resection for lung cancer ≤2 cm.
low-dose computed tomography
lung cancer screening
minimally invasive surgery
non–small cell lung cancer
sublobar resection
Journal
The Journal of thoracic and cardiovascular surgery
ISSN: 1097-685X
Titre abrégé: J Thorac Cardiovasc Surg
Pays: United States
ID NLM: 0376343
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
received:
01
05
2018
revised:
09
01
2019
accepted:
21
01
2019
pubmed:
8
4
2019
medline:
25
2
2020
entrez:
8
4
2019
Statut:
ppublish
Résumé
Sublobar resection (SLR) is an alternative to lobectomy for early non-small cell lung cancer. Comparative effectiveness of these 2 approaches might be modified by the extent of lymph node dissection. We utilized the Surveillance, Epidemiology, and End Results Program-Medicare dataset to identify patients with stage I non-small cell lung cancer aged 66 years or older with tumor size ≤2 cm. We compared patient characteristics with t tests for continuous variables and χ Among 2757 lobectomies and 1229 SLR procedures performed for stage I tumors ≤2 cm, we propensity-matched 1124 patients from each group. Patients undergoing SLR were more likely to have no lymph nodes sampled (46.9% vs 6.4%; P < .001). OS (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.29-1.69) and CSS (HR, 2.06; 95% CI, 1.41-3.02) were worse following SLR. When propensity-matched cohorts of patients with at least 1 lymph node removed (n = 567 each group) were examined, the HRs for survival for SLR decreased (OS HR, 1.38; 95% CI, 1.12-1.69; CSS HR, 1.58; 95% CI, 0.97-2.57). Finally, when cohorts were propensity matched for ≥9 lymph nodes examined (n = 103 each group), there was no difference in OS (HR, 0.84; 95% CI, 0.50-1.39) or CSS (HR, 1.10; 95% CI, 0.35-3.41). SLR leads to fewer lymph node removed and is associated with inferior survival compared with lobectomy. A more extensive lymphadenectomy may be associated with equivalent survival between matched patients undergoing SLR and lobectomy.
Sections du résumé
BACKGROUND
Sublobar resection (SLR) is an alternative to lobectomy for early non-small cell lung cancer. Comparative effectiveness of these 2 approaches might be modified by the extent of lymph node dissection.
METHODS
We utilized the Surveillance, Epidemiology, and End Results Program-Medicare dataset to identify patients with stage I non-small cell lung cancer aged 66 years or older with tumor size ≤2 cm. We compared patient characteristics with t tests for continuous variables and χ
RESULTS
Among 2757 lobectomies and 1229 SLR procedures performed for stage I tumors ≤2 cm, we propensity-matched 1124 patients from each group. Patients undergoing SLR were more likely to have no lymph nodes sampled (46.9% vs 6.4%; P < .001). OS (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.29-1.69) and CSS (HR, 2.06; 95% CI, 1.41-3.02) were worse following SLR. When propensity-matched cohorts of patients with at least 1 lymph node removed (n = 567 each group) were examined, the HRs for survival for SLR decreased (OS HR, 1.38; 95% CI, 1.12-1.69; CSS HR, 1.58; 95% CI, 0.97-2.57). Finally, when cohorts were propensity matched for ≥9 lymph nodes examined (n = 103 each group), there was no difference in OS (HR, 0.84; 95% CI, 0.50-1.39) or CSS (HR, 1.10; 95% CI, 0.35-3.41).
CONCLUSIONS
SLR leads to fewer lymph node removed and is associated with inferior survival compared with lobectomy. A more extensive lymphadenectomy may be associated with equivalent survival between matched patients undergoing SLR and lobectomy.
Identifiants
pubmed: 30954298
pii: S0022-5223(19)30533-1
doi: 10.1016/j.jtcvs.2019.01.136
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2454-2465.e1Subventions
Organisme : FDA HHS
ID : U01 FD005478
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2019. Published by Elsevier Inc.