Survival following segmentectomy and lobectomy for stage I non-small cell lung cancer.

Abstract

7064 Background: Although lobectomy is considered the standard surgical treatment forstage IA non–small cell lung cancer (NSCLC), limited resections are frequently performed for patients with poor lung function or high operative risk. Recent studies suggest that segmentectomy may be the superior limited resection procedure. The objective of this study was to compare survival among patients with stage IA (≤3cm) NSCLC undergoing lobectomy vs. segmentectomy. Methods: Using the Surveillance, Epidemiology and End Results registry we identified 15,180 cases of stage IA NSCLC that underwent lobectomy or segmentectomy. We used logistic regression to determine propensity scores for patients undergoing segmentectomy based on the patient’s preoperative characteristics. Overall and lung cancer-specific survival of patients treated with lobectomy versus segmentectomy was compared after adjusting, stratifying, or matching patients based on their propensity score. We also performed secondary analyses in subgroups of age (≤70 vs. >70 years) and tumor size ≤2 cm. Results: Overall, 1,200 (8%) patients underwent segmentectomy. Among the entire cohort, analyses adjusting for propensity scores did not demonstrate a difference in outcomes among patients treated with lobectomy versus segmentectomy, (adjusted hazard ratio [HR] for overall survival 1.11, 95% confidence interval [CI]: 0.94 – 1.30 and lung cancer-specific survival 1.11, 95% CI: 0.98 – 1.25). Similarly, secondary analyses showed no difference in overall (HR: 1.12, 95% CI: 0.90 – 1.40) and lung cancer-specific survival (HR: 1.04, 95% CI: 0.88 – 1.24) among patients with tumors ≤2 cm (T1a tumors). For patients ≤70 years of age, no difference in overall survival was observed (HR: 0.97, 95% CI: 0.73 – 1.28); however, a lung cancer-specific survival advantage of lobectomy was observed (HR: 1.19, 95% CI: 1.00 – 1.40). Finally, among those >70 years overall survival (HR: 1.03, 95% CI: 0.87 – 1.22) and lung cancer-specific survival (HR: 1.18, 95% CI: 0. 97 – 1.44) showed equivalence of the two surgical groups. Conclusions: Segmentectomy and lobectomy may lead to equivalent survival rates among patients with stage IA NSCLC. These study findings should be confirmed in prospective studies.