Survival and Long-Term Cause-Specific Mortality Associated With Stage IA Lung Adenocarcinoma After Wedge Resection vs. Segmentectomy: A Population-Based Propensity Score Matching and Competing Risk Analysis.

Mengnan Zhao,Mingxiang Feng,Jiacheng Yin,Ming Li,Qun Wang,Tian Jiang,Xinyu Yang,Cheng Zhan,Tao Lu,Yiwei Huang

doi:10.3389/fonc.2019.00593

Abstract

Background: Limited resection has been carried out increasingly in early stage NSCLC as an alternative to standard lobectomy. This study aimed to investigate the differences in survival and long-term cause-specific mortality between wedge resection and segmentectomy for treatment of stage IA lung adenocarcinoma.Method: Cases with primary lung adenocarcinoma that received wedge resection and segmentectomy between 2004 and 2015 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching was performed to balance the baseline covariates. Long-term cause-specific mortality was investigated through competing risk analysis. The overall survival (OS) was estimated with the Kaplan-Meier method with the log-rank test. Univariate and multivariate Cox proportional hazards regression analyses were performed to identify the independent prognostic factors.Results: Of the 3,046 cases included, 2,360 and 686 cases underwent wedge resection and segmentectomy, respectively. After propensity score matching, 686 pairs were selected. Segmentectomy was associated with a significantly better OS in stage IA2, grade I/II, female, and married patients. The segmentectomy group had a higher lung-cancer specific mortality in 65–74 years of age, stage IA1 and IA3, male, and married patients, and a lower chronic obstructive pulmonary disease (COPD) specific mortality in ≤64 and 65–74 years of age, stage IA1, IA2, and IA3, all grade, male, and married patients. The cardiovascular disease (CVD) specific mortality was also lower in the segmentectomy group in ≥75 years of age, stage IA1 and IA3, and grade I/II patients.Conclusion: Wedge resection was inferior to segmentectomy in terms of OS regarding all included parameters. In most cases, the segmentectomy group had higher lung-cancer specific mortality and lower COPD and CVD specific mortality.

Highlights

Lung cancer remains the leading cause of cancer-related deaths worldwide, and adenocarcinoma is the most frequent histological subtype [1, 2]
We retrospectively investigated the survival and mortality differences between wedge resection and segmentectomy for stage IA lung adenocarcinoma by performing propensity score matching and competing risk analysis using large data from the Surveillance, Epidemiology, and End Results (SEER) database
Patients with wedge resection were more likely to have tumors originating from the right lung (p = 0.006), to be diagnosed with early stage (p < 0.001), and to die of chronic obstructive pulmonary disease (COPD)/cardiovascular disease (CVD) (p = 0.002) (Table 1)

Summary

Introduction

Lung cancer remains the leading cause of cancer-related deaths worldwide, and adenocarcinoma is the most frequent histological subtype [1, 2]. Several treatment modalities have been applied to prolong the survival of patients with lung adenocarcinoma [3]. Lobectomy has been recommended as the standard procedure for early stage non-small-cell lung cancer (NSCLC) by the Lung Cancer Study Group [4]. For patients with severely compromised pulmonary function, severe comorbidities, or other situations that preclude lobectomy, limited pulmonary resection (wedge resection and segmentectomy) is used as an effective alternative. Wedge resection is generally considered a non-anatomical approach with less lymph node dissection [5]. Limited resection has been carried out increasingly in early stage NSCLC as an alternative to standard lobectomy. This study aimed to investigate the differences in survival and long-term cause-specific mortality between wedge resection and segmentectomy for treatment of stage IA lung adenocarcinoma

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Conclusion