Abstract
BackgroundNo consensus was reached on the surgical procedure for patients with stage I non-small-cell lung cancer (NSCLC) ≤ 2 cm. The aim of this study is to investigate the appropriate surgical procedure for stage I NSCLC ≤2 cm.MethodsPatients with stage I NSCLC ≤2 cm received wedge resection, segmentectomy, lobectomy between January 2004 and December 2015 were identified using the Surveillance, Epidemiology, and End Results (SEER) database. Data were stratified by age, gender, race, side, location, grade, histology, extent of lymphadenectomy. Overall survival (OS) and lung cancer-specific survival (LCSS) were compared among patients received wedge resection, segmentectomy, lobectomy. Univariate analysis and multivariable Cox regression were performed to identify the prognostic factors of OS and LCSS.ResultsA total of 16,511 patients with stage I NSCLC ≤2 cm were included in this study, of whom 2945 patients were classified as stage I NSCLC ≤1 cm. Lobectomy had better OS and LCSS when compared with wedge resection in patients with NSCLC ≤2 cm. Only OS favored lobectomy compared with segmentectomy in stage I NSCLC>1 to 2 cm. Multivariable analysis showed that segmentectomy had similar OS and LCSS compared with lobectomy in patients with stage I NSCLC ≤2 cm. Lymph node dissection (LND) was associated with better OS in patients with NSCLC ≤2 cm and better LCSS in patients with stage I NSCLC>1 to 2 cm.ConclusionsSegmentectomy showed comparable survival compared with lobectomy in patients with stage I NSCLC ≤2 cm. LND can provide more accurate pathological stage, may affect survival, and should be recommended for above patients.
Highlights
Lung cancer is the leading cause of cancer death, and approximately 85% of all diagnoses are non-small-cell lung cancer (NSCLC) [1, 2]
The survival analysis by log-rank test showed that wedge resection had obviously worse Overall survival (OS) (hazard ratio (HR), 1.59; 95% CI, 1.36 to 1.86; P < 0.001) and lung cancer-specific survival (LCSS) (HR, 1.58; 95% CI, 1.27 to 1.96; P < 0.001) than lobectomy in patients with NSCLC ≤1 cm (Fig. 1A, B, Table 3)
When patients with lobectomy were divided into lobectomy with Lymph node dissection (LND) and lobectomy without LND, lobectomy without LND showed obvious worse OS (HR, 1.40; 95% CI, 1.11 to 1.74; P < 0.001) and LCSS (HR, 1.41; 95% CI, 1.04 to 1.91; P = 0.018) than lobectomy with LND (Fig. 1C, D, Table 3)
Summary
Lung cancer is the leading cause of cancer death, and approximately 85% of all diagnoses are non-small-cell lung cancer (NSCLC) [1, 2]. Lobectomy is generally accepted as the standard treatment for stage I NSCLC ≤3 cm [4], no consensus on extent of lung resection is reached for stage I NSCLC ≤2 cm. It is generally accepted that systematic nodal dissection can provide more accurate pathological stage and influence the indication of adjuvant treatment which may affect survival. Some surgeons believed that systematic nodal dissection is important for NSCLC even in early stage patients since it can improve survival [5, 6]. Some surgeons concluded that systematic mediastinal lymph node dissection is not necessary for clinically evaluated peripheral non-small-cell carcinomas smaller than 2 cm in diameter since it cannot improve survival [7]. No consensus was reached on the surgical procedure for patients with stage I non-small-cell lung cancer (NSCLC) ≤ 2 cm. The aim of this study is to investigate the appropriate surgical procedure for stage I NSCLC ≤2 cm
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