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Abstract
BackgroundTo investigate the differences in survival between lobectomy and sub-lobar resection for elderly stage I non-small-cell lung cancer (NSCLC) patients using the Surveillance, Epidemiology, and End Results (SEER) registry.MethodThe data of stage IA elderly NSCLC patients (≥ 70 years) with tumors less than or equal to 3 cm in diameter were extracted. Propensity-matched analysis was used. Lung cancer-specific survival (LCSS) was compared among the patients after lobectomy and sub-lobar resection. The proportional hazards model was applied to identify multiple prognostic factors.ResultsA total of 3,504 patients met criteria after propensity score matching (PSM). Although the LCSS was better for lobectomy than for sub-lobar resection in patients with tumors ≤ 3 cm before PSM (p < 0.001), no significant difference in the LCSS was identified between the two treatment groups after PSM (p = 0.191). Multivariate Cox regression showed the elder age, male gender, squamous cell carcinoma (SQC) histology type, poor/undifferentiated grade and a large tumor size were associated with poor LCSS. The subgroup analysis of tumor sizes, histologic types and lymph nodes (LNs) dissection, there were also no significant difference for LCSS between lobectomy and sub-lobar resection. The sub-lobar resection was further divided into segmentectomy or wedge resection, and it demonstrated that no significant differences in LCSS were identified among the treatment subgroups either. Multivariate Cox regression analysis showed that the elder age, poor/undifferentiated grade and a large tumor size were a statistically significant independent factor associated with survival.ConclusionIn terms of LCSS, lobectomy has no significant advantage over sub-lobar resection in elderly patients with stage IA NSCLC if lymph node assessment is performed adequately. The present data may contribute to develop a more suitable surgical treatment strategy for the stage IA elderly NSCLC patients.
Highlights
Lung cancer is a major public health problem worldwide and is the leading cause of death in the United States [1]
The Lung cancer-specific survival (LCSS) was better for lobectomy than for sub-lobar resection in patients with tumors ≤ 3 cm before propensity score matching (PSM) (p < 0.001), no significant difference in the LCSS was identified between the two treatment groups after PSM (p = 0.191)
The sub-lobar resection was further divided into segmentectomy or wedge resection, and it demonstrated that no significant differences in LCSS were identified among the treatment subgroups either
Summary
Lung cancer is a major public health problem worldwide and is the leading cause of death in the United States [1]. Lobectomy shows better survival than sub-lobar resection for patients with NSCLC tumors ≤ 1 cm and > 1 to 2 cm [7]. There is an increasing amount of evidence that sub-lobar resection, when applied in appropriate patient populations, can provide excellent oncologic results and no significant difference survival to lobectomy. A post hoc analysis of an international, randomized, phase 3 trial showed that the morbidity rates did not seem to differ between lobectomy and sub-lobar resection for early-stage (≤ 1 cm) NSCLC [9]. A retrospective study indicated that sub-lobar resection might achieve similar survival rates to lobectomy in elderly stage I NSCLC patients [10]. To investigate the differences in survival between lobectomy and sub-lobar resection for elderly stage I non-small-cell lung cancer (NSCLC) patients using the Surveillance, Epidemiology, and End Results (SEER) registry
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