Limited Resection for the Treatment of Patients With Stage IA Lung Cancer
Limited Resection for the Treatment of Patients With Stage IA Lung Cancer
Objective: Lobectomy is the standard of care for stage IA lung cancer. Some small retrospective studies have suggested similar results after limited resection for tumors ≤2 cm in size. The objective of the study was to compare survival after lobectomy and limited resection among Medicare patients with lung cancer.
Methods: Using the Surveillance, Epidemiology, and End Results registry, linked to Medicare records, we identified 1165 cases of stage I lung cancer ≤2 cm in size that underwent lobectomy or limited resection (segmentectomy or wedge resection). We used logistic regression to determine propensity scores for undergoing limited resection based on the patients' preoperative characteristics. Overall and lung cancer-specific survival of patients treated with lobectomy or limited resection was compared after adjusting for their propensity score.
Results: Overall, 196 (17%) patients underwent limited resection. For the entire sample, the adjusted hazard ratio for all cause mortality (1.09; 95% confidence interval: 0.85–1.40) or lung cancer-specific death (hazard ratio: 1.39; 95% confidence interval: 0.97–2.01) for patients undergoing limited resection were not significantly different from those having lobectomy. Similarly, we found no significant differences in overall or lung cancer-specific survival for patients treated with limited resection compared with lobectomy when data was analyzed stratifying and matching patients by their propensity scores.
Conclusions: These results suggest that survival of patients >65 years of age undergoing limited resection or lobectomy for stage IA tumors ≤2 cm appears to be similar. Although these findings should be confirmed in prospective trials, our results suggest that limited resection may be an effective therapeutic alternative for these patients.
Lung cancer is predominantly a disease of older adults. In the United States >50% of cases of lung cancer are diagnosed in patients older than 65 years of age with a peak incidence between 65 and 74 years. Although the prognosis of patients with non-small cell lung cancer (NSCLC) remains poor, surgically resected patients with stage IA disease have 5-year survival rates as high as 70% and the best chance to be cured.
The standard treatment for stage I NSCLC is lobectomy with mediastinal lymph node sampling or dissection. A controversial topic in the surgical management of these patients is the role of limited resection for stage IA lesions, especially those ≤2 cm in diameter. Current recommendations for anatomic lobectomy for these patients are based on the results of a single trial in which 267 patients with stage IA tumors ≤3 cm were randomly assigned to lobectomy or limited resection. This study showed that the lobectomy group had a significantly lower rate of loco-regional recurrence and a trend towards better survival. However, several more recent retrospective studies have suggested that limited resection and lobectomy may lead to similar outcomes among patients with smaller (≤2 cm) stage I NSCLC. If sublobar resection is proven to be equivalent to lobectomy in terms of survival, limited resections may be preferred as they are associated with better preservation of pulmonary function, reduced morbidity and disability and increased likelihood of surgical intervention in the event of a secondary primary lung cancer, particularly among patients with limited pulmonary function or elderly individuals.
The objective of this study was to compare the outcomes of patients >65 years of age with stage IA NSCLC ≤2 cm in size after lobectomy or limited resection using a large, nationally representative cancer registry.
Abstract and Introduction
Abstract
Objective: Lobectomy is the standard of care for stage IA lung cancer. Some small retrospective studies have suggested similar results after limited resection for tumors ≤2 cm in size. The objective of the study was to compare survival after lobectomy and limited resection among Medicare patients with lung cancer.
Methods: Using the Surveillance, Epidemiology, and End Results registry, linked to Medicare records, we identified 1165 cases of stage I lung cancer ≤2 cm in size that underwent lobectomy or limited resection (segmentectomy or wedge resection). We used logistic regression to determine propensity scores for undergoing limited resection based on the patients' preoperative characteristics. Overall and lung cancer-specific survival of patients treated with lobectomy or limited resection was compared after adjusting for their propensity score.
Results: Overall, 196 (17%) patients underwent limited resection. For the entire sample, the adjusted hazard ratio for all cause mortality (1.09; 95% confidence interval: 0.85–1.40) or lung cancer-specific death (hazard ratio: 1.39; 95% confidence interval: 0.97–2.01) for patients undergoing limited resection were not significantly different from those having lobectomy. Similarly, we found no significant differences in overall or lung cancer-specific survival for patients treated with limited resection compared with lobectomy when data was analyzed stratifying and matching patients by their propensity scores.
Conclusions: These results suggest that survival of patients >65 years of age undergoing limited resection or lobectomy for stage IA tumors ≤2 cm appears to be similar. Although these findings should be confirmed in prospective trials, our results suggest that limited resection may be an effective therapeutic alternative for these patients.
Introduction
Lung cancer is predominantly a disease of older adults. In the United States >50% of cases of lung cancer are diagnosed in patients older than 65 years of age with a peak incidence between 65 and 74 years. Although the prognosis of patients with non-small cell lung cancer (NSCLC) remains poor, surgically resected patients with stage IA disease have 5-year survival rates as high as 70% and the best chance to be cured.
The standard treatment for stage I NSCLC is lobectomy with mediastinal lymph node sampling or dissection. A controversial topic in the surgical management of these patients is the role of limited resection for stage IA lesions, especially those ≤2 cm in diameter. Current recommendations for anatomic lobectomy for these patients are based on the results of a single trial in which 267 patients with stage IA tumors ≤3 cm were randomly assigned to lobectomy or limited resection. This study showed that the lobectomy group had a significantly lower rate of loco-regional recurrence and a trend towards better survival. However, several more recent retrospective studies have suggested that limited resection and lobectomy may lead to similar outcomes among patients with smaller (≤2 cm) stage I NSCLC. If sublobar resection is proven to be equivalent to lobectomy in terms of survival, limited resections may be preferred as they are associated with better preservation of pulmonary function, reduced morbidity and disability and increased likelihood of surgical intervention in the event of a secondary primary lung cancer, particularly among patients with limited pulmonary function or elderly individuals.
The objective of this study was to compare the outcomes of patients >65 years of age with stage IA NSCLC ≤2 cm in size after lobectomy or limited resection using a large, nationally representative cancer registry.