Stage I NSCLC: segmentectomy effective in node-positive disease

  • Lutfi W & al.
  • Clin Lung Cancer
  • 1 Apr 2019

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Segmentectomy offered similar OS to lobectomy in patients found to have node-positive stage I NSCLC.
  • Patients who underwent lobectomy had higher rates of nodal upstaging than those who underwent segmentectomy.

Why this matters

  • This study is the first to identify prognostic factors for nodal upstaging in early-stage NSCLC segmentectomy patients, including increasing tumor size, squamous cell histology, and increasing number of lymph nodes sampled.

Study design

  • 4556 patients from the National Cancer Database with stage I NSCLC underwent segmentectomy (n=115) or lobectomy (n=4441) and found to have pathologic N stage I or II.
  • Funding: None disclosed.

Key results

  • No significant difference in 3-year OS between segmentectomy and lobectomy (66.3% vs 68.1%; HR, 0.91; P=.562).
  • Lobectomy was associated with higher rates of nodal upstaging (9.5% vs 4.6%; P<.001>
  • After multivariable analysis, significant predictors of node-positive disease after segmentectomy included increasing tumor size (OR, 2.13; P<.001 squamous cell histology p=".029)," and increasing number of lymph nodes sampled>

Limitations

  • Retrospective analysis.