Early NSCLC: sublobar resection inferior to lobectomy for large tumors

  • Stiles BM & al.
  • Eur J Cardiothorac Surg
  • 5 Jun 2019

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Sublobar resection (SLR) for large stage I, node-negative (N0) NSCLC tumors was associated with 27% increase in all-cause mortality and 57% increase in cancer-specific mortality.
  • However, study authors suggest SLR's high cancer-specific survival rate may make it an appropriate option for high-risk patients with carefully staged large N0 tumors.

Why this matters

  • SLR is used in as many as 31% of surgical resection cases for clinically node-negative lung cancers, despite a lack of data from randomized clinical trials comparing oncological outcomes vs lobectomy.

Study design

  • 4582 patients with stage I NSCLC N0 tumors >2 cm to 5 cm in size from the Surveillance, Epidemiology and End Results and Medicare-linked databases underwent SLR (n=692) or lobectomy (n=3890).
  • 681 propensity-matched patient pairs.
  • Funding: None disclosed.

Key results

  • After matching, the SLR group was more likely to have no lymph node sampling (44.1% vs 7.5%; P<.001>
  • After propensity-matching, the lobectomy group had better 5-year OS (47% vs 37%; P<.001 and cancer-specific survival vs p>
  • SLR was associated with an increased risk of all-cause mortality (HR, 1.27; P=.001) and cancer-specific mortality death (HR, 1.57; P=.008).

Limitations

  • Retrospective design.