Comparison of long-term prognosis in elderly stageⅠnon-small cell lung cancer patients undergoing lobectomy or segmentectomy: A propensity score matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 CUI Hui , SHI Yong , YU Yongkang , HU Xiang

Department of Thoracic and Cardiac Surgery, Meishan City People's Hospital, Meishan, 620010, Sichuan, P. R. China;

Corresponding author：

CUI Hui, Email: 292246@163.com

Keywords：

Non-small cell lung cancer; elderly patients; stageⅠ; lobectomy; segmentectomy; prognosis

DOI：

10.7507/1007-4848.202406030

Video：

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Objective To compare the long-term prognosis of elderly patients with stageⅠnon-small cell lung cancer (NSCLC) after lobectomy or segmentectomy. Methods Data of elderly patients with stageⅠNSCLC were collected from the SEER database. According to the resection method, patients were divided into a lobectomy group and a segmentectomy group. The overall survival (OS) and lung cancer-specific survival (LCSS) of the two groups were compared by propensity score matching (lobectomy : segmentectomy=2:1). Results A total of 9990 patients were included, including 5840 (58.46%) females and 4150 (41.54%) males, with an average age of 70.48±6.47 years. Among them, 9029 patients were in the lobectomy group and 961 patients were in the segmentectomy group. After propensity score matching, a total of 2883 patients were matched, including 1922 patients in the lobectomy group and 961 patients in the segmentectomy group. There was no statistical difference in baseline data between the two groups (P>0.05). The 10-year OS rate and LCSS rate of the lobectomy group were higher than those of the segmentectomy group (OS: 51.15% vs. 38.35%, P<0.01; LCSS: 79.68% vs. 71.52%, P<0.01). Subgroup analysis found that the survival advantage of lobectomy was only limited to patients aged 60-70 years; for patients>70 years, there was no statistical difference in the 5-year and 10-year OS rates between the two surgical methods (P>0.05). In addition, for patients with tumor diameter ≤2 cm (stages ⅠA1-ⅠA2), lymph node dissection number≥10, and receiving adjuvant radiotherapy/chemotherapy, segmentectomy could also achieve a similar prognosis as lobectomy. Conclusion Overall, for elderly patients with stage ⅠNSCLC, lobectomy can achieve better OS and LCSS. However, individual differences, tumor characteristics, and perioperative treatment plans should be considered comprehensively to determine whether elderly patients with stageⅠNSCLC should undergo segmentectomy.

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20.	中国抗癌协会肺癌专业委员会, 中华医学会肿瘤学分会肺癌学组, 中国胸部肿瘤研究协作组. Ⅰ~ⅢB期非小细胞肺癌完全切除术后辅助治疗指南(2021版). 中华医学杂志, 2021, 101(16): 1132-1142.Lung Cancer Professional Committee of the Chinese Anti-Cancer Association, Lung Cancer Group of the Tumor Branch of the Chinese Medical Association, and China Chest Tumor Research Collaboration Group. Guidelines for adjuvant treatment after complete resection of stage I-IIIB non-small cell lung cancer (2021 edition). Natl Med J Chin, 2021, 101(16): 1132-1142.
21.	Yang F, Sui X, Chen X, et al. Comparison between sublobar resection and lobectomy for the surgical treatment of elderly patients with early stage non-small-cell lung cancer (STEPS): An open label, multicentre, non-inferiority, randomised, phase 3 clinical trial. Lancet Oncol, 2017, 18(Suppl 1): S2.

1. Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022. J Natl Cancer Cent, 2024, 4(1): 47-53.
2. American Cancer Society. Cancer facts & figures 2019. URL: https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2019.html. Accessed on 2024-04-15.
3. Hattori A, Suzuki K, Takamochi K, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer with radiologically pure-solid appearance in Japan (JCOG0802/WJOG4607L): A post-hoc supplemental analysis of a multicentre, open-label, phase 3 trial. Lancet Respir Med, 2024, 12(2): 105-116.
4. Saji H, Okada M, Tsuboi M, et al. 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(10335): 1607-1617.
5. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Non-small Cell Lung Cancer, Version 4 2024. Accessed on 2024-04-15.
6. Chen C, Kolbe J, Christmas T. Surgical treatment of non-small-cell lung cancer in octogenarians: A single-centre retrospective study. Intern Med J, 2021, 51(4): 596-599.
7. Kirk F, Chang S, Yong MS, et al. Thoracic surgery and the elderly: Is lobectomy safe in octogenarians? Heart Lung Circ, 2023, 32(6): 755-762.
8. 吴水晶, 娄景盛. 中国老年患者围手术期感染防治的麻醉专家共识. 中华老年多器官疾病杂志, 2022, 21(12): 881-887.Wu SJ, Lou JS. Anesthesiology expert consensus on the prevention and treatment of perioperative infections in elderly patients in China. Chin J Mult Organ Dis Elder, 2022, 21(12): 881-887.
9. Yang J, Xia Y, Yang Y, et al. Risk factors for major adverse events of video-assisted thoracic surgery lobectomy for lung cancer. Int J Med Sci, 2014, 11(9): 863-869.
10. 陈军, 车国卫, 孙大强, 等. 老年肺癌外科治疗中国专家共识(2022版). 中国肺癌杂志, 2023, 26(2): 83-92.Chen J, Che GW, Sun DQ, et al. Consensus of Chinese experts on surgical treatment of lung cancer in the elderly (2022 edition). Chin J Lung Cancer, 2023, 26(2): 83-92.
11. Wang T, Zhou J, Wang Y, et al. Clinicopathological characteristics and prognosis of resectable lung adenosquamous carcinoma: A population-based study of the SEER database. Jpn J Clin Oncol, 2022, 52(10): 1191-1200.
12. Zhang Z, Gayle AA, Wang J, et al. Comparing baseline characteristics between groups: An introduction to the CBCgrps package. Ann Transl Med, 2017, 5(24): 484.
13. Zhang Z, Feng H, Zhao H, et al. Sublobar resection is associated with better perioperative outcomes in elderly patients with clinical stage I non-small cell lung cancer: A multicenter retrospective cohort study. J Thorac Dis, 2019, 11(5): 1838-1848.
14. Darras M, Ojanguren A, Forster C, et al. Short-term local control after VATS segmentectomy and lobectomy for solid NSCLC of less than 2 cm. Thorac Cancer, 2021, 12(4): 453-461.
15. Zhang B, Liu R, Ren D, et al. Comparison of lobectomy and sublobar resection for stage ⅠA elderly NSCLC patients (≥70 years): A population-based propensity score matching's study. Front Oncol, 2021, 11: 610638.
16. 王俊, 赵辉. 亚肺叶切除治疗早期肺癌需要考虑的几个问题. 中国肺癌杂志, 2016, 19(6): 351-354.Wang J, Zhao H. Issues need to be considered in sublobectomy for early stage lung cancer. Chin J Lung Cancer, 2016, 19(6): 351-354.
17. Liang W, He J, Shen Y, et al. Impact of examined lymph node count on precise staging and long-term survival of resected non-small-cell lung cancer: A population study of the US SEER Database and a Chinese Multi-Institutional Registry. J Clin Oncol, 2017, 35(11): 1162-1170.
18. 黄汉清, 叶波. 肿瘤实性成分占比在早期周围型肺癌诊疗中的研究进展. 中国肺癌杂志, 2022, 25(10): 764-770.Huang HQ, Ye B. Research progress in the effect of consolidation tumor ratio on the diagnosis and treatment of early-stage peripheral lung cancer. Chin J Lung Cancer, 2022, 25(10): 764-770.
19. 陈亮, 方文涛. 肺叶切除及肺段切除治疗早期非小细胞疗效对比研究进展. 中国肺癌杂志, 2019, 22(8): 526-531.Chen L, Fang WT. A review on comparison of lobectomy and segmentectomy in the treatment of early stage non-small cell lung cancer. Chin J Lung Cancer, 2019, 22(8): 526-531.
20. 中国抗癌协会肺癌专业委员会, 中华医学会肿瘤学分会肺癌学组, 中国胸部肿瘤研究协作组. Ⅰ~ⅢB期非小细胞肺癌完全切除术后辅助治疗指南(2021版). 中华医学杂志, 2021, 101(16): 1132-1142.Lung Cancer Professional Committee of the Chinese Anti-Cancer Association, Lung Cancer Group of the Tumor Branch of the Chinese Medical Association, and China Chest Tumor Research Collaboration Group. Guidelines for adjuvant treatment after complete resection of stage I-IIIB non-small cell lung cancer (2021 edition). Natl Med J Chin, 2021, 101(16): 1132-1142.
21. Yang F, Sui X, Chen X, et al. Comparison between sublobar resection and lobectomy for the surgical treatment of elderly patients with early stage non-small-cell lung cancer (STEPS): An open label, multicentre, non-inferiority, randomised, phase 3 clinical trial. Lancet Oncol, 2017, 18(Suppl 1): S2.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesComparison of long-term prognosis in elderly stageⅠnon-small cell lung cancer patients undergoing lobectomy or segmentectomy: A propensity score matching study

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