Abstract
PurposeTo determine the survival following segmentectomy versus lobectomy in elderly patients with early-stage non-small cell lung cancer (NSCLC).MethodsWe identified 12324 elderly (≥ 70 years) patients with stage I ≤ 3 cm NSCLC in the Surveillance, Epidemiology and End Results (SEER) database. Propensity score methods were used to balance baseline characteristics of patients undergoing segmentectomy or lobectomy. Overall survival (OS) and lung cancer-specific survival (LCSS) of patients treated with segmentectomy versus lobectomy were compared in Cox regression models after adjusting, stratifying or matching patients based on propensity scores.ResultsCox models adjusting, stratifying or matching propensity scores all showed that patients treated with segmentectomy had significantly worse OS and LCSS compared to lobectomy. Subgroup analysis of patients with tumors ≤ 2cm, aged ≥ 75 years, or had ≥ 7 lymph nodes examined also revealed survival advantage associated with lobectomy.ConclusionElder age alone could not justify the application of segmentectomy in early-stage lung cancer. Prospective randomized trials are warranted to validate our results.
Highlights
Controversy remains as to whether sublobar resection including segmentectomy and wedge resection could be a reasonable alternative to lobectomy in the treatment of early-stage non-small cell lung cancers (NSCLC)
Cox models adjusting, stratifying or matching propensity scores all showed that patients treated with segmentectomy had significantly worse Overall survival (OS) and lung cancer-specific survival (LCSS) compared to lobectomy
Subgroup analysis of patients with tumors ≤ 2cm, aged ≥ 75 years, or had ≥ 7 lymph nodes examined revealed survival advantage associated with lobectomy
Summary
Controversy remains as to whether sublobar resection including segmentectomy and wedge resection could be a reasonable alternative to lobectomy in the treatment of early-stage non-small cell lung cancers (NSCLC). The only randomized controlled trial (RCT) comparing lobectomy and sublobar resection in earlystage lung cancer (T1N0) showed that lobectomy was associated with a lower rate of local recurrence and a tendency towards better overall survival [1]. A recent study comparing segmentectomy and wedge resection using the Surveillance, Epidemiology and End Results (SEER) database showed that segmentectomy was associated with significant improvement in overall and lung cancerspecific survival [2]. As a result, limited resection may be a more reasonable alternative to lobectomy in elderly patients with early-stage lung cancer. We used SEER database to compare the survival outcomes following segmentectomy versus lobectomy in elderly patients ≥ 70 years old with stage I NSCLC ≤ 3 cm in size
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