INTRODUCTION: Although lobectomy is considered the standard surgical treatment for stage IA non-small-cell lung cancer (NSCLC), wedge resection or segmentectomy are frequently performed on patients who are not lobectomy candidates. The objective of this study was to compare survival among patients with stage IA NSCLC, who are undergoing these procedures. METHODS: Using the Surveillance, Epidemiology and End Results registry, we identified 3525 patients. 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 wedge resection versus segmentectomy was compared after adjusting, stratifying, or matching patients based on propensity score. RESULTS: Overall, 704 patients (20%) underwent segmentectomy. Analyses, adjusting for propensity scores, showed that segmentectomy was associated with significant improvement in overall (hazard ratio: 0.80, 95% confidence interval: 0.69-0.93) and lung cancer-specific survival (hazard ratio: 0.72, 95% confidence interval: 0.59-0.88) compared with wedge resection. Similar results were obtained when stratifying and matching by propensity score and when limiting analysis to patients with tumors sized less than or equal to 2 cm, or aged 70 years or younger. CONCLUSIONS: These results suggest that segmentectomy should be the preferred technique for limited resection of patients with stage IA NSCLC. The study findings should be confirmed in prospective studies.
INTRODUCTION: Although lobectomy is considered the standard surgical treatment for stage IA non-small-cell lung cancer (NSCLC), wedge resection or segmentectomy are frequently performed on patients who are not lobectomy candidates. The objective of this study was to compare survival among patients with stage IA NSCLC, who are undergoing these procedures. METHODS: Using the Surveillance, Epidemiology and End Results registry, we identified 3525 patients. 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 wedge resection versus segmentectomy was compared after adjusting, stratifying, or matching patients based on propensity score. RESULTS: Overall, 704 patients (20%) underwent segmentectomy. Analyses, adjusting for propensity scores, showed that segmentectomy was associated with significant improvement in overall (hazard ratio: 0.80, 95% confidence interval: 0.69-0.93) and lung cancer-specific survival (hazard ratio: 0.72, 95% confidence interval: 0.59-0.88) compared with wedge resection. Similar results were obtained when stratifying and matching by propensity score and when limiting analysis to patients with tumors sized less than or equal to 2 cm, or aged 70 years or younger. CONCLUSIONS: These results suggest that segmentectomy should be the preferred technique for limited resection of patients with stage IA NSCLC. The study findings should be confirmed in prospective studies.
Authors: Nicole Ezer; Rajwanth R Veluswamy; Grace Mhango; Kenneth E Rosenzweig; Charles A Powell; Juan P Wisnivesky Journal: J Thorac Oncol Date: 2015-08 Impact factor: 15.609