Choice of surgical procedure for patients with non-small-cell lung cancer ≤ 1 cm or > 1 to 2 cm among lobectomy, segmentectomy, and wedge resection: A population-based study

Chenyang Dai, Jianfei Shen, Yijiu Ren, Shengyi Zhong, Hui Zheng, Jiaxi He, Dong Xie, Ke Fei, Wenhua Liang, Gening Jiang, Ping Yang, Rene Horsleben Petersen, Calvin S H Ng, Chia Chuan Liu, Gaetano Rocco, Alessandro Brunelli, Yaxing Shen, Chang Chen, Jianxing He

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: According to the lung cancer staging project, T1a (≤ 2 cm) non-small-cell lung cancer (NSCLC) should be additionally classified into ≤ 1 cm and > 1 to 2 cm groups. This study aimed to investigate the surgical procedure for NSCLC ≤ 1 cm and > 1 to 2 cm. Methods: We identified 15,760 patients with T1aN0M0 NSCLC after surgery from the Surveillance, Epidemiology, and End Results database. Overall survival (OS) and lung cancer-specific survival (LCSS) were compared among patients after lobectomy, segmentectomy, or wedge resection. The proportional hazards model was applied to evaluate multiple prognostic factors. Results: OS and LCSS favored lobectomy compared with segmentectomy or wedge resection in patients with NSCLC ≤ 1 cm and > 1 to 2 cm. Multivariable analysis showed that segmentectomy and wedge resection were independently associated with poorer OS and LCSS than lobectomy for NSCLC ≤ 1 cm and > 1 to 2 cm. With sublobar resection, lower OS and LCSS emerged for NSCLC > 1 to 2 cm after wedge resection, whereas similar survivals were observed for NSCLC ≤ 1cm. Multivariable analyses showed that wedge resection is an independent risk factor of survival for NSCLC > 1 to 2 cm but not for NSCLC ≤ 1 cm. Conclusion: Lobectomy showed better survival than sublobar resection for patients with NSCLC ≤ 1 cm and > 1 to 2 cm. For patients in whom lobectomy is unsuitable, segmentectomy should be recommended for NSCLC > 1 to 2 cm, whereas surgeons could rely on surgical skills and the patient profile to decide between segmentectomy and wedge resection for NSCLC ≤ 1 cm.

Original languageEnglish
Pages (from-to)3175-3182
Number of pages8
JournalJournal of Clinical Oncology
Volume34
Issue number26
DOIs
Publication statusPublished - Sep 10 2016

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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