Abstract
Background
The standard surgical procedure for ≤ 2 cm non-small cell lung cancer (NSCLC), including
the number of lymph nodes sampled (nLN) and surgical modality, remains controversial.
This study was designed to determine the optimal cohort in which sublobectomy could
be an alternative to lobectomy.
Materials (or Patients) and Methods
Patients from 1998 to 2017 were identified from the Surveillance, Epidemiology, and
End Results (SEER) database. The optimal cutoff value of nLN was identified using
a restrictive cubic spline graph (RCS). Kaplan–Meier analysis was used to determine
cancer-specific survival (CSS). The COX proportional hazard regression model was used
to identify the influence of clinical and demographic variables on survival, and propensity
score matching (PSM) was used to balance differences in baseline characteristics.
Finally, we used an external cohort from a single-center medical institution to verify
the conclusions drawn from the SEER database.
Results
A total of 6150 patients were included. The sublobectomy subgroup included segmentectomy
(308, 5.0%) and wedge resection (1611, 26.2%). The cutoff value for nLN was 7. In
the nLN ≥7 subgroup of the PSM cohort, the CSS of segmentectomy and wedge resection
was close to that of the lobectomy subgroup (P = .12), whereas in the nLN <7 subgroup, the CSS of the lobectomy subgroup was significantly
higher than that of the sublobectomy with P < .001). Surgical methods, nLN, age, sex, and differentiated grade were independent
predictors of CSS. External cohort validation: A total of 1106 patients from the Affiliated
Jinhua Hospital of Zhejiang University School of Medicine between 2013 and 2020 were
included. The grouping criteria were consistent with the SEER database. In the nLN≥7
subgroup, sublobectomy had a survival outcome similar to that of lobectomy (P = .81).
Conclusion
Sublobectomy and nLN < 7 were strongly associated with poorer CSS for early-stage
NSCLC. On the premise of nLN ≥ 7, sublobectomy could provide similar survival outcomes
to lobectomy for these patients.
Keywords
Abbreviations:
NSCLC (Non-small cell lung cancer), SCLC (Small cell lung cancer), LN (Lymph node(s)), nLN (Number of lymph nodes sampled), SEER (Surveillance, Epidemiology, and End Results), CSS (Lungcancer-specificsurvival), OS (Overall survival), RFS (Recurrence-free survival), PSM (Propensity score matching analysis), RCS (Restrictive cubic spline), HR (Hazard ratio), CI (Confidence intervals), SCC (Squamous cell carcinoma), AC (Adenocarcinoma)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 25, 2022
Accepted:
December 20,
2022
Received in revised form:
December 16,
2022
Received:
June 23,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
