Abstract
Purpose: To compare the survival outcomes following segmentectomy or wedge resection in early-stage lung cancer.Methods: A total of 5880 patients with invasive lung adenocarcinoma or squamous cell carcinoma from the Surveillance, Epidemiology, and End Results (SEER) database were included in this study, of which 1156 received segmentectomy. Baseline characteristics were balanced using propensity score methods. Cox regression analysis was used to compare overall survival (OS) and lung cancer-specific survival (LCSS) following segmentectomy or wedge resection after matching patients based on propensity scores.Results: Overall, patients undergoing segmentectomy and wedge resection had no significant different OS and LCSS both in the invasive adenocarcinoma group and the squamous cell carcinoma group. Segmentectomy was associated with improved OS (hazard ratio = 0.626, 95% confidence interval: 0.457-0.858, P = 0.004) and LCSS (hazard ratio = 0.643, 95% CI: 0.440-0.939, P = 0.022) in invasive adenocarcinoma patients ≤ 65 years old. In patients with ≤ 2 cm invasive adenocarcinoma, segmentectomy was associated with significantly better OS (hazard ratio = 0.811, 95% confidence interval: 0.666-0.988, P = 0.038).Conclusion: Survival following segmentectomy or wedge resection was generally equivalent in lung invasive adenocarcinoma and squamous cell carcinoma. However, invasive adenocarcinoma patients who were ≤ 65 years or had tumors ≤ 2 cm in size may have improved survival outcomes after segmentectomy.
Highlights
The National Lung Screening Trial (NLST) results encouraged the early detection of lung cancer by computed tomography (CT) screen [1]
Segmentectomy was associated with improved overall survival (OS) and lung cancer-specific survival (LCSS) in invasive adenocarcinoma patients ≤ 65 years old
In patients with ≤ 2 cm invasive adenocarcinoma, segmentectomy was associated with significantly better OS
Summary
The National Lung Screening Trial (NLST) results encouraged the early detection of lung cancer by computed tomography (CT) screen [1]. In 1995, the Lung Cancer Study Group (LCSG) published the only randomized clinical trial on surgical approaches for stage IA non-small cell lung cancer (NSCLC) [2]. This trial demonstrated that lobectomy was associated with improved survival outcomes compared to limited resection (segmentectomy and wedge resection) [2]. Only a few studies compared the efficacy between the two sublobar resection types, segmentectomy and wedge resection, providing insufficient evidence regarding selection of appropriate limited resection types in early stage lung cancer [5, 6, 9, 10]
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