TY - JOUR
T1 - Surgeons' preference sublobar resection for stage I NSCLC less than 3 cm
AU - Huang, Chien Sheng
AU - Hsu, Po Kuei
AU - Chen, Chun Ku
AU - Yeh, Yi Chen
AU - Hsu, Han Shui
AU - Shih, Chun Che
AU - Huang, Biing Shiun
N1 - Publisher Copyright:
© 2020 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Background: This study aimed to compare survival between standard lobectomy and surgeons' preference sublobar resection among patients with stage I non-small cell lung cancer (NSCLC). Methods: Medical records of patients undergoing pulmonary resection between 2006 and 2016 were reviewed retrospectively. Differences in disease-free survival (DFS) and DFS-associated factors between patients receiving lobectomy and surgeons' preference sublobar resection were analyzed after 1-1 propensity score-matching (n = 119 per group). Results: In total, 1064 pathological stage I NSCLC patients were identified, including 816 (76.7%) who underwent lobectomy, 111 (10.4%) who underwent sublobar resection as a compromised procedure (medically unfit), and 137 (12.9%) who underwent surgeons' preference sublobar resection. Rates of five-year DFS for patients undergoing lobectomy, medically unfit, and surgeons' preference sublobar resection were 88.7%, 71.0%, and 93.4%, respectively (P < 0.001). Multivariable Cox regression analysis demonstrated that radiological solid-appearance (adjusted hazard [aHR] = 2.908, P = 0.003), PL2 invasion (aHR = 1.970, P = 0.024), and angiolymphatic invasion (aHR = 2.202, P = 0.005) were significantly associated with lower DFS after adjusting for surgeons' preference sublobar resection (aH = 1.031, P = 0.939). Subgroup analysis of all 403 solid-dominant patients demonstrated equivalent five-year DFS between surgeons' preference sublobar resection and lobectomy (87.7% and 84.1%, respectively, P = 0.721). Propensity-matched analysis showed no differences in five-year DFS in stage I NSCLC patients undergoing lobectomy or surgeons' preference sublobar resection (90.5% vs. 93.4% P = 0.510), and DFS for surgeons' preference sublobar resection remained an insignificant factor (aHR = 0.894, P = 0.834). Conclusions: Carefully selected patients who have undergone surgeons' preference sublobar resection have comparable outcomes to those receiving lobectomy for stage I NSCLC <3 cm. Key points: Significant findings of the study Intended sublobar resection has a good outcome. What this study adds Sublobar resection is applicable for stage I NSCLC <3 cm.
AB - Background: This study aimed to compare survival between standard lobectomy and surgeons' preference sublobar resection among patients with stage I non-small cell lung cancer (NSCLC). Methods: Medical records of patients undergoing pulmonary resection between 2006 and 2016 were reviewed retrospectively. Differences in disease-free survival (DFS) and DFS-associated factors between patients receiving lobectomy and surgeons' preference sublobar resection were analyzed after 1-1 propensity score-matching (n = 119 per group). Results: In total, 1064 pathological stage I NSCLC patients were identified, including 816 (76.7%) who underwent lobectomy, 111 (10.4%) who underwent sublobar resection as a compromised procedure (medically unfit), and 137 (12.9%) who underwent surgeons' preference sublobar resection. Rates of five-year DFS for patients undergoing lobectomy, medically unfit, and surgeons' preference sublobar resection were 88.7%, 71.0%, and 93.4%, respectively (P < 0.001). Multivariable Cox regression analysis demonstrated that radiological solid-appearance (adjusted hazard [aHR] = 2.908, P = 0.003), PL2 invasion (aHR = 1.970, P = 0.024), and angiolymphatic invasion (aHR = 2.202, P = 0.005) were significantly associated with lower DFS after adjusting for surgeons' preference sublobar resection (aH = 1.031, P = 0.939). Subgroup analysis of all 403 solid-dominant patients demonstrated equivalent five-year DFS between surgeons' preference sublobar resection and lobectomy (87.7% and 84.1%, respectively, P = 0.721). Propensity-matched analysis showed no differences in five-year DFS in stage I NSCLC patients undergoing lobectomy or surgeons' preference sublobar resection (90.5% vs. 93.4% P = 0.510), and DFS for surgeons' preference sublobar resection remained an insignificant factor (aHR = 0.894, P = 0.834). Conclusions: Carefully selected patients who have undergone surgeons' preference sublobar resection have comparable outcomes to those receiving lobectomy for stage I NSCLC <3 cm. Key points: Significant findings of the study Intended sublobar resection has a good outcome. What this study adds Sublobar resection is applicable for stage I NSCLC <3 cm.
KW - Early stage lung cancer
KW - non-small cell lung cancer
KW - segmentectomy
KW - sublobar resection
KW - wedge resection
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U2 - 10.1111/1759-7714.13336
DO - 10.1111/1759-7714.13336
M3 - Article
C2 - 32037690
AN - SCOPUS:85079457867
SN - 1759-7706
VL - 11
SP - 907
EP - 917
JO - Thoracic Cancer
JF - Thoracic Cancer
IS - 4
ER -