Long-term survival analysis of sublobar resection versus lobectomy for older patients with early-stage pulmonary carcinoid tumour: a database-based propensity score-matched study.

Abstract

The optimal extent of surgery for older patients with early-stage pulmonary carcinoid tumour (PC) remains controversial. To compare prognostic differences between sublobar resection versus lobectomy in older patients with early-stage PC. The SEER database was searched for stage T1N0M0 PC patients aged ≥ 65years who underwent lobectomy or sublobar resection from 2000 to 2017. Propensity score matching (PSM) was used to determine intergroup covariate differences. Kaplan-Meier curves and the log-rank test were used for intergroup comparison of overall survival (OS). A Cox proportional hazard model was used to evaluate independent risk factors. Among 1023 participants, 650 and 373 underwent lobectomy and sublobar resection, respectively. Before PSM, the 5- and 10-year OS in the sublobar resection group were lower than that of the lobectomy group (5-year OS 84.12% vs. 91.16%; 10-year OS 57.43% vs. 64.77%; p = 0.014); after PSM, no significant prognostic difference existed between lobectomy and sublobar resection (5-year OS 88.17% vs. 89.23%; 10-year OS 58.32% vs. 62.75%; p = 0.811). Subgroup analysis included tumour size, age, number of lymph nodes examined and histological type, and showed no statistically significant survival differences between the lobectomy and sublobar resection groups. Multivariable Cox analysis indicated that age ≥ 77years, male sex, inadequate lymph node assessment (< 7), and atypical carcinoid were associated with reduced OS. Sublobar resection showed a similar long-term survival rate for early-stage PC patients aged ≥ 65years as with lobectomy, thereby providing a basis for the selection of surgical methods for PC.