Survival analysis of stage ⅠA non-small cell lung cancer patients with lobectomy and sublobar resection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Wenke , ZHANG Lin ,  ZHANG Shuguang

Department of Thoracic Surgery, The First Affiliated Hospital of China Medical University, Shenyang, 110001, P.R.China;

Corresponding author：

ZHANG Shuguang, Email: shgzhang@cmu.edu.cn

Keywords：

Non-small cell lung cancer; lobectomy; segmentectomy; wedge resection; survival analysis

DOI：

10.7507/1007-4848.201607059

Video：

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Objective To make a survival analysis for the stage ⅠA non-small cell lung cancer patients who underwent lobectomy, segmentectomy or wedge resection and to discuss whether the segmentectomy and wedge resection can be used as a conventional operation. Methods The clinical data of 474 patients diagnosed with ⅠA non-small cell lung cancer from January 2012 to June 2015 in the First Affiliated Hospital of China Medical University were retrospectively anlyzed. There were 192 males and 282 females with a mean age of 60 years. Their sex, age, histological type, tumor size, surgical pattern, smoking, drinking, survival rate, disease-free survival rate, recurrence rate were compared. Results Disease-free survival rate of patients with wedge resection was significantly lower than that of the patients undergoing lobectomy and segmentectomy (P<0.05). When tumor diameter≤19 mm, the disease-free survival rate of patients with wedge resection was lower than that of patients with lobectomy (P=0.006) and segmentectomy (P=0.065). Disease-free survival rate of patients with tumor diameter of 20-<30 mm was significantly lower than that of patients with tumor diameter≤19 mm (P=0.026). Excluding patients with wedge resection, disease-free survival of the patients with lobectomy and segmentectomy and tumor diameter of 20-<30 mm was significantly lower than that of patients with tumor diameter≤19 mm (P=0.036). Patients with wedge resection had significant higher risk of local recurrence than that of patients undergoing lobectomy (P<0.001) and segmentectomy (P=0.002). Conclusion StageⅠA non-small cell lung cancer patients undergoing segmentectomy can obtain approximate survival and disease-free survival rate compared with those with lobectomy, especially in patients with tumor diameter≤19 mm. Pulmonary wedge resection as surgical treatment of lung cancer patients must be selected carefully according to the actual situation and surgical purposes.

Citation： LIU Wenke, ZHANG Lin, ZHANG Shuguang. Survival analysis of stage ⅠA non-small cell lung cancer patients with lobectomy and sublobar resection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(10): 768-773. doi: 10.7507/1007-4848.201607059 Copy

1.	McGuire S. World Cancer Report 2014. Geneva, Switzerland: World Health Organization, International Agency for Research on Cancer, WHO Press, 2015. Adv Nutr, 2016, 7(2): 418-419.
2.	Zhang Y, Sun Y, Wang R, et al. Meta-analysis of lobectomy segmentectomy and wedge resection for stage I non-small cell lung cancer. J Surg Oncol, 2015, 111(3): 334-340.
3.	Zhang L, Li M, Yin R, et al. Comparison of the oncologic outcomes of anatomic segmentectomy and lobectomy for early-stage non-small cell lung cancer. Ann Thorac Surg, 2015, 99(2): 728-737.
4.	Cao C, Chandrakumar D, Gupta S, et al. 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(2): 121-132.
5.	Goldstraw P, Crowley J, Chansky K, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol, 2007, 2(8): 706-714.
6.	Graham EA, Singer JJ. Successful removal of an entire lung for carcinoma of the bronchus. JAMA, 1933, 101: 1371-1374.
7.	Churchill ED, Sweet RH, Soutter L, et al. The surgical management of carcinoma of the lung. J Thoracic Surg, 1950, 20: 349-365.
8.	Hoffmann TH, Ransdell HT. Comparison of lobectomy and wedge resection for carcinoma of the lung. J Thorac Cardiovasc Surg, 1980, 79(2): 211-217.
9.	Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-623.
10.	Dembitzer FR, Flores RM, Parides MK, et al. Impact of histologic subtyping on outcome in lobar vs sublobar resections for lung cancer: a pilot study. Chest, 2014, 146(1): 175-181.
11.	Altorki NK, Yip R, Hanaoka T, et al. Sublobar resection is equivalent to lobectomy for clinical stage 1A lung cancer in solid nodules. J Thorac Cardiovasc Surg, 2014, 147(2): 754-762.
12.	McGuire AL, Hopman WM, Petsikas D, et al. Outcomes: wedge resection versus lobectomy for non-small cell lung cancer at the Cancer Centre of Southeastern Ontario 1998-2009. Can J Surg, 2013, 56(6): E165-E170.
13.	Kodama K, Higashiyama M, Okami J, et al. Oncologic outcomes of segmentectomy versus lobectomy for clinical T1a N0 M0 non-small cell lung cancer. Ann Thorac Surg, 2016, 101(2): 504-511.
14.	Tsutani Y, Miyata Y, Nakayama H, et al. Oncologic outcomes of segmentectomy compared with lobectomy for clinical stageⅠA lung adenocarcinoma: propensity score-matched analysis in a multicenter study. J Thorac Cardiovasc Surg, 2013, 146(2): 358-364.
15.	Yendamuri S, Sharma R, Demmy M, et al. Temporal trends in outcomes following sublobar and lobar resections for small (≤ 2 cm) non-small cell lung cancers--a Surveillance Epidemiology End Results database analysis. J Surg Res, 2013, 183(1): 27-32.
16.	Whitson BA, Groth SS, Andrade RS, et al. Survival after lobectomy versus segmentectomy for stageⅠnon-small cell lung cancer: a population-based analysis. Ann Thorac Surg, 2011, 92(6): 1943-1950.
17.	Zhang Y, Yuan C, Zhang Y, et al. Survival following segmentectomy or lobectomy in elderly patients with early-stage lung cancer. Oncotarget, 2016, 7(14): 19081-19086.
18.	Carr SR, Schuchert MJ, Pennathur A, et al. 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 Thorac Cardiovasc Surg, 2012, 143(2): 390-397.
19.	National Institutes of Health. National Cancer Institute. CALGB-140503. Phase Ⅲ randomized study of lobectomy versus sublobar resection in patients with small peripheral stage ⅠA non-small cell lung cancer. https://www.georgiacancerinfo.org/clinical-trials/lung-cancer/2591. Accessed March 16, 2010.
20.	Nakamura K, Saji H, Nakajima R, et al. A phase Ⅲ randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). Jpn J Clin Oncol, 2010, 40(3): 271-274.

1. McGuire S. World Cancer Report 2014. Geneva, Switzerland: World Health Organization, International Agency for Research on Cancer, WHO Press, 2015. Adv Nutr, 2016, 7(2): 418-419.
2. Zhang Y, Sun Y, Wang R, et al. Meta-analysis of lobectomy segmentectomy and wedge resection for stage I non-small cell lung cancer. J Surg Oncol, 2015, 111(3): 334-340.
3. Zhang L, Li M, Yin R, et al. Comparison of the oncologic outcomes of anatomic segmentectomy and lobectomy for early-stage non-small cell lung cancer. Ann Thorac Surg, 2015, 99(2): 728-737.
4. Cao C, Chandrakumar D, Gupta S, et al. 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(2): 121-132.
5. Goldstraw P, Crowley J, Chansky K, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol, 2007, 2(8): 706-714.
6. Graham EA, Singer JJ. Successful removal of an entire lung for carcinoma of the bronchus. JAMA, 1933, 101: 1371-1374.
7. Churchill ED, Sweet RH, Soutter L, et al. The surgical management of carcinoma of the lung. J Thoracic Surg, 1950, 20: 349-365.
8. Hoffmann TH, Ransdell HT. Comparison of lobectomy and wedge resection for carcinoma of the lung. J Thorac Cardiovasc Surg, 1980, 79(2): 211-217.
9. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg, 1995, 60(3): 615-623.
10. Dembitzer FR, Flores RM, Parides MK, et al. Impact of histologic subtyping on outcome in lobar vs sublobar resections for lung cancer: a pilot study. Chest, 2014, 146(1): 175-181.
11. Altorki NK, Yip R, Hanaoka T, et al. Sublobar resection is equivalent to lobectomy for clinical stage 1A lung cancer in solid nodules. J Thorac Cardiovasc Surg, 2014, 147(2): 754-762.
12. McGuire AL, Hopman WM, Petsikas D, et al. Outcomes: wedge resection versus lobectomy for non-small cell lung cancer at the Cancer Centre of Southeastern Ontario 1998-2009. Can J Surg, 2013, 56(6): E165-E170.
13. Kodama K, Higashiyama M, Okami J, et al. Oncologic outcomes of segmentectomy versus lobectomy for clinical T1a N0 M0 non-small cell lung cancer. Ann Thorac Surg, 2016, 101(2): 504-511.
14. Tsutani Y, Miyata Y, Nakayama H, et al. Oncologic outcomes of segmentectomy compared with lobectomy for clinical stageⅠA lung adenocarcinoma: propensity score-matched analysis in a multicenter study. J Thorac Cardiovasc Surg, 2013, 146(2): 358-364.
15. Yendamuri S, Sharma R, Demmy M, et al. Temporal trends in outcomes following sublobar and lobar resections for small (≤ 2 cm) non-small cell lung cancers--a Surveillance Epidemiology End Results database analysis. J Surg Res, 2013, 183(1): 27-32.
16. Whitson BA, Groth SS, Andrade RS, et al. Survival after lobectomy versus segmentectomy for stageⅠnon-small cell lung cancer: a population-based analysis. Ann Thorac Surg, 2011, 92(6): 1943-1950.
17. Zhang Y, Yuan C, Zhang Y, et al. Survival following segmentectomy or lobectomy in elderly patients with early-stage lung cancer. Oncotarget, 2016, 7(14): 19081-19086.
18. Carr SR, Schuchert MJ, Pennathur A, et al. 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 Thorac Cardiovasc Surg, 2012, 143(2): 390-397.
19. National Institutes of Health. National Cancer Institute. CALGB-140503. Phase Ⅲ randomized study of lobectomy versus sublobar resection in patients with small peripheral stage ⅠA non-small cell lung cancer. https://www.georgiacancerinfo.org/clinical-trials/lung-cancer/2591. Accessed March 16, 2010.
20. Nakamura K, Saji H, Nakajima R, et al. A phase Ⅲ randomized trial of lobectomy versus limited resection for small-sized peripheral non-small cell lung cancer (JCOG0802/WJOG4607L). Jpn J Clin Oncol, 2010, 40(3): 271-274.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Survival analysis of stage ⅠA non-small cell lung cancer patients with lobectomy and sublobar resection

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