CALGB140503 study: Is sublobectomy the standard procedure for early peripheral lung cancer?_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WU Sikai , WANG Zimin , SUN Hua ,  ZHU Chengchu ,  SHEN Jianfei

Department of Cardiothoracic Surgery, Taizhou Hospital, Zhejiang University, Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Wenzhou, 325035, Zhejiang, P. R. China;

Corresponding author：

ZHU Chengchu, Email: tzyyzhucc@126.com; SHEN Jianfei, Email: jianfei051@163.com

Keywords：

Non-small cell lung cancer; lobectomy; sublobectomy; clinical prognosis

DOI：

10.7507/1007-4848.202303086

Video：

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Abstract Full text Figures/Tables Video References Cited by

While lobectomy is the standard surgical procedure for early-stage non-small cell lung cancer (NSCLC), sublobectomy (segmentectomy/wedge resection) has been gaining progress in early-stage peripheral NSCLC in recent years because it preserves more lung parenchyma and has the advantages of good postoperative lung function, relatively less trauma, and faster recovery. However, there has been a lack of standardized randomized clinical trials to study the survival benefits of sublobectomy. The results of a high-profile study from the USA, CALGB140503, have been the subject of intense industry debate since its presentation at the 2022 World Conference on Lung Cancer (IASLC WCLC 2022). The study, which was published in The New England Journal of Medicine on February 9, 2023, was designed to investigate whether sublobectomy was not inferior to lobectomy in terms of survival in patients with early-stage peripheral NSCLC (tumor diameter≤2 cm). The results showed that sublobectomy was not worse than lobectomy for survival in patients with T1aN0M0 peripheral NSCLC with tumor diameter≤2 cm and pathologically confirmed negative hilar and mediastinal lymph nodes. Sublobectomy, including anatomical segmentectomy and wedge resection is an effective NSCLC treatment. The results of this study provide strong evidence for the improved outcomes of sublobectomy in terms of lung function protection and are expected to promote the further use of sublobectomy. However, given the limitations of this study, whether sublobectomy, especially wedge resection, can become a standard procedure still needs to be explored. This paper presents an interpretation of this study and we invite experts in the field to discuss its usefulness in guiding clinical practice and summarise its limitations.

Citation： WU Sikai, WANG Zimin, SUN Hua, ZHU Chengchu, SHEN Jianfei. CALGB140503 study: Is sublobectomy the standard procedure for early peripheral lung cancer?. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(8): 1097-1101. doi: 10.7507/1007-4848.202303086 Copy

1.	Ginsberg RJ, Rubinstein LV, Lung Cancer Study Group. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Ann Thorac Surg, 1995, 60(3): 615-622.
2.	Altorki NK, Yip R, Hanaoka T, et al. Sublobar resection is equivalent to lobectomy for clinical stage ⅠA lung cancer in solid nodules. J Thorac Cardiovasc Surg, 2014, 147(2): 754-764.
3.	Onaitis MW, Furnary AP, Kosinski AS, et al. Equivalent survival between lobectomy and segmentectomy for clinical stage ⅠA lung cancer. Ann Thorac Surg, 2020, 110(6): 1882-1891.
4.	Landreneau RJ, Normolle DP, Christie NA, et al. Recurrence and survival outcomes after anatomic segmentectomy versus lobectomy for clinical stage Ⅰ non-small-cell lung cancer: A propensitymatched analysis. J Clin Oncol, 2014, 32(23): 2449-2455.
5.	Kates M, Swanson S, Wisnivesky JP. 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(3): 491-496.
6.	Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in smallsized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
7.	Altorki N, Wang X, Kozono D, et al. Lobar or sublobar resection for peripheral stage ⅠA non-small-cell lung cancer. N Engl J Med, 2023, 388(6): 489-498.
8.	Kohman LJ, Gu L, Altorki N, et al. Biopsy first: Lessons learned from cancer and leukemia group B (CALGB) 140503. J Thorac Cardiovasc Surg, 2017, 153: 1592-1597.
9.	周健, 肖丛佳, 蒲强, 等. 周围型实性小结节肺癌(直径≤2 cm)术后复发转移危险因素分析及手术方式对生存影响的倾向性评分匹配研究. 中国胸心血管外科临床杂志, 2021, 28(11): 1283-1291.
10.	Wu S, Wang Z, Sun J, et al. Survival outcomes of sublobectomy and lobectomy in elderly patients with peripheral solid-dominant non-small cell lung cancer. Ann Surg Oncol, 2022, 30(3): 1522-1529.
11.	Kamel MK, Lee B, Harrison SW, et al. Sublobar resection is comparable to lobectomy for screen-detected lung cancer. J Thorac Cardiovasc Surg, 2022, 163(6): 1907-1915.
12.	Ling L, Zheng H, Lin H, et al. Adequate number of lymph nodes sampled may determine appropriate surgical modality for early-stage NSCLC: A population-based real-world study. Clin Lung Cancer, 2022, 24(3): e141-e151.

1. Ginsberg RJ, Rubinstein LV, Lung Cancer Study Group. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Ann Thorac Surg, 1995, 60(3): 615-622.
2. Altorki NK, Yip R, Hanaoka T, et al. Sublobar resection is equivalent to lobectomy for clinical stage ⅠA lung cancer in solid nodules. J Thorac Cardiovasc Surg, 2014, 147(2): 754-764.
3. Onaitis MW, Furnary AP, Kosinski AS, et al. Equivalent survival between lobectomy and segmentectomy for clinical stage ⅠA lung cancer. Ann Thorac Surg, 2020, 110(6): 1882-1891.
4. Landreneau RJ, Normolle DP, Christie NA, et al. Recurrence and survival outcomes after anatomic segmentectomy versus lobectomy for clinical stage Ⅰ non-small-cell lung cancer: A propensitymatched analysis. J Clin Oncol, 2014, 32(23): 2449-2455.
5. Kates M, Swanson S, Wisnivesky JP. 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(3): 491-496.
6. Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in smallsized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet, 2022, 399(10335): 1607-1617.
7. Altorki N, Wang X, Kozono D, et al. Lobar or sublobar resection for peripheral stage ⅠA non-small-cell lung cancer. N Engl J Med, 2023, 388(6): 489-498.
8. Kohman LJ, Gu L, Altorki N, et al. Biopsy first: Lessons learned from cancer and leukemia group B (CALGB) 140503. J Thorac Cardiovasc Surg, 2017, 153: 1592-1597.
9. 周健, 肖丛佳, 蒲强, 等. 周围型实性小结节肺癌(直径≤2 cm)术后复发转移危险因素分析及手术方式对生存影响的倾向性评分匹配研究. 中国胸心血管外科临床杂志, 2021, 28(11): 1283-1291.
10. Wu S, Wang Z, Sun J, et al. Survival outcomes of sublobectomy and lobectomy in elderly patients with peripheral solid-dominant non-small cell lung cancer. Ann Surg Oncol, 2022, 30(3): 1522-1529.
11. Kamel MK, Lee B, Harrison SW, et al. Sublobar resection is comparable to lobectomy for screen-detected lung cancer. J Thorac Cardiovasc Surg, 2022, 163(6): 1907-1915.
12. Ling L, Zheng H, Lin H, et al. Adequate number of lymph nodes sampled may determine appropriate surgical modality for early-stage NSCLC: A population-based real-world study. Clin Lung Cancer, 2022, 24(3): e141-e151.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

CALGB140503 study: Is sublobectomy the standard procedure for early peripheral lung cancer?

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