Chenyang Dai1, Jianfei Shen1, Yijiu Ren1, Shengyi Zhong1, Hui Zheng1, Jiaxi He1, Dong Xie1, Ke Fei1, Wenhua Liang1, Gening Jiang1, Ping Yang1, Rene Horsleben Petersen1, Calvin S H Ng1, Chia-Chuan Liu1, Gaetano Rocco1, Alessandro Brunelli1, Yaxing Shen1, Chang Chen1, Jianxing He2. 1. Chenyang Dai, Yijiu Ren, Hui Zheng, Dong Xie, Ke Fei, Gening Jiang, Chang Chen, Shanghai Pulmonary Hospital, Tongji University School of Medicine; and Yaxing Shen, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China; Jianfei Shen, Shengyi Zhong, Jiaxi He, Wenhua Liang, Jianxing He, First Affiliated Hospital of Guangzhou Medical University and Guangzhou Research Institute of Respiratory Disease, Guangzhou, People's Republic of China; Ping Yang, Mayo Clinic College of Medicine, Rochester, MN; Rene Horsleben Petersen, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark; Calvin S.H. Ng, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong; Chia-Chuan Liu, Sun Yat-Sen Cancer Center, Taiwan; Gaetano Rocco, National Cancer Institute, Pascale Foundation, Naples, Italy; and Alessandro Brunelli, St James's University Hospital, Leeds, United Kingdom. 2. Chenyang Dai, Yijiu Ren, Hui Zheng, Dong Xie, Ke Fei, Gening Jiang, Chang Chen, Shanghai Pulmonary Hospital, Tongji University School of Medicine; and Yaxing Shen, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China; Jianfei Shen, Shengyi Zhong, Jiaxi He, Wenhua Liang, Jianxing He, First Affiliated Hospital of Guangzhou Medical University and Guangzhou Research Institute of Respiratory Disease, Guangzhou, People's Republic of China; Ping Yang, Mayo Clinic College of Medicine, Rochester, MN; Rene Horsleben Petersen, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark; Calvin S.H. Ng, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong; Chia-Chuan Liu, Sun Yat-Sen Cancer Center, Taiwan; Gaetano Rocco, National Cancer Institute, Pascale Foundation, Naples, Italy; and Alessandro Brunelli, St James's University Hospital, Leeds, United Kingdom drjianxing.he@gmail.com.
Abstract
PURPOSE: According to the lung cancer staging project, T1a (≤ 2 cm) non-small-cell lung cancer (NSCLC) should be additionally classified into ≤ 1 cm and > 1 to 2 cm groups. This study aimed to investigate the surgical procedure for NSCLC ≤ 1 cm and > 1 to 2 cm. METHODS: We identified 15,760 patients with T1aN0M0 NSCLC after surgery from the Surveillance, Epidemiology, and End Results database. Overall survival (OS) and lung cancer-specific survival (LCSS) were compared among patients after lobectomy, segmentectomy, or wedge resection. The proportional hazards model was applied to evaluate multiple prognostic factors. RESULTS: OS and LCSS favored lobectomy compared with segmentectomy or wedge resection in patients with NSCLC ≤ 1 cm and > 1 to 2 cm. Multivariable analysis showed that segmentectomy and wedge resection were independently associated with poorer OS and LCSS than lobectomy for NSCLC ≤ 1 cm and > 1 to 2 cm. With sublobar resection, lower OS and LCSS emerged for NSCLC > 1 to 2 cm after wedge resection, whereas similar survivals were observed for NSCLC ≤ 1 cm. Multivariable analyses showed that wedge resection is an independent risk factor of survival for NSCLC > 1 to 2 cm but not for NSCLC ≤ 1 cm. CONCLUSION: Lobectomy showed better survival than sublobar resection for patients with NSCLC ≤ 1 cm and > 1 to 2 cm. For patients in whom lobectomy is unsuitable, segmentectomy should be recommended for NSCLC > 1 to 2 cm, whereas surgeons could rely on surgical skills and the patient profile to decide between segmentectomy and wedge resection for NSCLC ≤ 1 cm.
PURPOSE: According to the lung cancer staging project, T1a (≤ 2 cm) non-small-cell lung cancer (NSCLC) should be additionally classified into ≤ 1 cm and > 1 to 2 cm groups. This study aimed to investigate the surgical procedure for NSCLC ≤ 1 cm and > 1 to 2 cm. METHODS: We identified 15,760 patients with T1aN0M0 NSCLC after surgery from the Surveillance, Epidemiology, and End Results database. Overall survival (OS) and lung cancer-specific survival (LCSS) were compared among patients after lobectomy, segmentectomy, or wedge resection. The proportional hazards model was applied to evaluate multiple prognostic factors. RESULTS: OS and LCSS favored lobectomy compared with segmentectomy or wedge resection in patients with NSCLC ≤ 1 cm and > 1 to 2 cm. Multivariable analysis showed that segmentectomy and wedge resection were independently associated with poorer OS and LCSS than lobectomy for NSCLC ≤ 1 cm and > 1 to 2 cm. With sublobar resection, lower OS and LCSS emerged for NSCLC > 1 to 2 cm after wedge resection, whereas similar survivals were observed for NSCLC ≤ 1 cm. Multivariable analyses showed that wedge resection is an independent risk factor of survival for NSCLC > 1 to 2 cm but not for NSCLC ≤ 1 cm. CONCLUSION: Lobectomy showed better survival than sublobar resection for patients with NSCLC ≤ 1 cm and > 1 to 2 cm. For patients in whom lobectomy is unsuitable, segmentectomy should be recommended for NSCLC > 1 to 2 cm, whereas surgeons could rely on surgical skills and the patient profile to decide between segmentectomy and wedge resection for NSCLC ≤ 1 cm.