Abstract

PurposeTo compare the survival difference among lobectomy, segmentectomy, and wedge resection and investigate the role of adjuvant chemotherapy for early-stage small-sized non-small cell lung cancer (NSCLC) with visceral pleural invasion (VPI).MethodsPatients diagnosed with stage IB peripheral NSCLC with VPI and ≤3 cm in size in the Surveillance, Epidemiology, and End Results database between 2004 and 2015 were included, and the pleural layer (PL) invasion status was identified to recognize the tumors with VPI, including PL1 and PL2. We conducted Cox proportional hazards model in multivariable analysis and subgroup analysis via propensity score matching (PSM) method and Cox regression method to figure out the optimal therapy for these patients.ResultsA total of 1,993 patients were included, all of whom received surgery, and the median follow-up was 33 months (range, 1–83 months). In multivariable analysis, age, gender, histology, pathological grade, lymph node examination, surgical approaches, and radiotherapy were independent prognostic factors for overall survival (OS). Lobectomy was superior to sublobar resection [hazard ratio (HR) = 1.41; 95% CI, 1.08–1.83], and wedge resection was associated with impaired survival compared to lobectomy (HR = 1.64; 95% CI, 1.22–2.20) in PSM analyses. In subgroup analysis, lobectomy was superior to sublobar resection among those aged <70 years (HR = 1.81; 95% CI, 1.13–2.90), female (HR = 1.75; 95% CI, 1.21–2.53), and 1–20 mm in size (HR = 1.61; 95% CI, 1.11–2.33). No survival benefit was observed for adjuvant chemotherapy.ConclusionsLobectomy was superior to wedge resection and comparable with segmentectomy for stage IB NSCLC (≤3 cm) with VPI, and adjuvant chemotherapy could not benefit these patients, even in those with sublobar resection. The preferred surgical procedure remains to be studied in prospective controlled trials.

Highlights

  • Visceral pleural invasion (VPI) was announced as the poor prognostic factor for early-stage non-small cell lung cancer (NSCLC), and previous research indicated that the T category of TNM classification would be further evaluated by VPI extent [1,2,3,4]

  • The purpose of this study was to compare the survival difference among lobectomy, segmentectomy, and wedge resection and investigate the role of adjuvant chemotherapy for stage IB peripheral NSCLC with VPI and ≤3 cm in size via propensity score matching (PSM) method in the Surveillance, Epidemiology, and End Results (SEER) database, which has been operated since 1973 by the National Cancer Institute

  • Patients diagnosed with stage IB peripheral NSCLC with VPI and ≤3 cm in size between 2004 and 2015 were included, and the inclusion and exclusion criteria were shown in a flowchart (Figure 1)

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Summary

Introduction

Visceral pleural invasion (VPI) was announced as the poor prognostic factor for early-stage non-small cell lung cancer (NSCLC), and previous research indicated that the T category of TNM classification would be further evaluated by VPI extent [1,2,3,4]. A tumor ≤3 cm in size with VPI and lymph node negative would be upstaged to T2, even though a tumor 3–5 cm in size without other clinicopathological characteristics specified was still T2 disease in the eighth edition of TNM classification [4]. While prior research indicated that the adverse effect of VPI might be mainly distributed in NSCLC with N0 disease and 1–3 cm in size, the additional effect of invasiveness on VPI was found weakened with N stage upstaging and tumor size increasing [9]. The role of VPI in small-sized early-stage NSCLC needs to be established further

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