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.
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).
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.
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)
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- Cancer statistics, 2015.CA Cancer J Clin. 2015; 65: 5-29
- Results of initial low-dose computed tomographic screening for lung cancer.New Eng J Med. 2013; 368: 1980-1991
- Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer.N Engl J Med. 2005; 352: 2589-2597
- Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer.N Engl J Med. 2004; 350: 351-360
- Lobectomy, sublobar resection, and stereotactic ablative radiotherapy for early-stage non-small cell lung cancers in the elderly.JAMA Surg. 2014; 149: 1244-1253
- Comparative effectiveness of surgery and radiosurgery for stage I non-small cell lung cancer.Cancer. 2015; 121: 2341-2349
- Treatment of stage I and II non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.Chest. 2013; 143: e278S-e313S
- Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer.Ann Thorac Surg. 1995; 60 (Lung Cancer Study Group) (discussion 22-3): 615-622
- Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: results of the American College of Surgery Oncology Group Z0030 Trial.J Thorac Cardiovasc Surg. 2011; 141: 662-670
- The impact of tumor size on the association of the extent of lymph node resection and survival in clinical stage I non-small cell lung cancer.Lung Cancer (Amsterdam, Netherlands). 2015; 90: 554-560
- Postoperative survival and the number of lymph nodes sampled during resection of node-negative non-small cell lung cancer.Chest. 2005; 128: 1545-1550
- Survival following lobectomy and limited resection for the treatment of stage I non-small cell lung cancer<=1 cm in size: a review of SEER data.Chest. 2011; 139: 491-496
- Effect of number of lymph nodes sampled on outcome in patients with stage I non-small-cell lung cancer.J Clin Oncol. 2003; 21: 1029-1034
- A standard for hilar and intrapulmonary lymph node dissection and pathological examination in early non-small cell lung cancer.Translat Lung Cancer Res. 2021; 10: 4587-4599
- Sublobar resections in stage IA non-small cell lung cancer: segmentectomies result in significantly better cancer-related survival than wedge resections.Eur J Cardiothorac Surg. 2008; 33: 728-734
- Impact of tumor size on outcomes after anatomic lung resection for stage 1A non-small cell lung cancer based on the current staging system.J Thor Cardiovasc Surg. 2012; 143: 390-397
- Anatomic segmentectomy in the treatment of stage I non-small cell lung cancer.Ann Thor Surg. 2007; 84 (discussion 32-3): 926-932
- Intraoperative sentinel lymph node mapping in non-small-cell lung cancer improves detection of micrometastases.J Clin Oncol. 2002; 20: 1984-1988
- Systematic lymph node dissection for clinically diagnosed peripheral non-small-cell lung cancer less than 2 cm in diameter.World J Surg. 1998; 22 (discussion 4-5): 290-294
- Japanese lung cancer registry study of 11,663 surgical cases in 2004: demographic and prognosis changes over decade.J Thorac Oncol. 2011; 6: 1229-1235
- Illustrated Anatomical Segmentectomy for Lung Cancer.Springer, Tokyo2012
- Could less be more?-A systematic review and meta-analysis of sublobar resections versus lobectomy for non-small cell lung cancer according to patient selection.Lung Cancer. 2015; 89: 121-132
- Single-arm study of sublobar resection for ground glass opacity dominant peripheral lung cancer.J Thoracic Cardiovasc Surg. 2020; 163: 289-301.e2
- Choice of surgical procedure for patients with non-small-cell lung cancer </= 1 cm or >1 to 2 cm among lobectomy, segmentectomy, and wedge resection: a population-based study.J Clin Onco. 2016; 34: 3175-3182
- Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial.Lancet. 2022; 399: 1607-1617
- CALGB 140503: A Randomized Phase III Trial of Lobectomy versus Sublobar Resection for Small (< 2cm) Peripheral Non-Small Cell Lung Cancer.Oncol Issues. 2017; 23: 20-21
- ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer.Eur J Cardiothorac Surg. Germany. 2006; 30: 787-792
- [Revised by the Japan lung cancer society: guideline for diagnosis and treatment of lung cancer].Gan To Kagaku Ryoho. 2011; 38: 1273-1276
- NCCN Guidelines in Colon Cancer.National Comprehensive Cancer Network, Pennsylvania2022 (Version 1)
- NCCN Guidelines in Esophageal and Esophagogastric Cancer.National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania2020 (Version 4)
- NCCN Guidelines in Gastric Cancer.National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania2022 (Version 2)
Published online: December 25, 2022
Accepted: December 20, 2022
Received in revised form: December 16, 2022
Received: June 23, 2022
Publication stageIn Press Journal Pre-Proof
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