Surgical Procedure Selection for Stage I Lung Cancer: Complex Segmentectomy versus Wedge Resection

Abstract Background No consensus was reached on the surgical procedure for patients with stage I non-small-cell lung cancer (NSCLC) ≤ 2 cm. The aim of this study is to investigate the appropriate surgical procedure for stage I NSCLC ≤2 cm. Methods Patients with stage I NSCLC ≤2 cm received wedge resection, segmentectomy, lobectomy between January 2004 and December 2015 were identified using the Surveillance, Epidemiology, and End Results (SEER) database. Data were stratified by age, gender, race, side, location, grade, histology, extent of lymphadenectomy. Overall survival (OS) and lung cancer-specific survival (LCSS) were compared among patients received wedge resection, segmentectomy, lobectomy. Univariate analysis and multivariable Cox regression were performed to identify the prognostic factors of OS and LCSS. Results A total of 16,511 patients with stage I NSCLC ≤2 cm were included in this study, of whom 2945 patients were classified as stage I NSCLC ≤1 cm. Lobectomy had better OS and LCSS when compared with wedge resection in patients with NSCLC ≤2 cm. Only OS favored lobectomy compared with segmentectomy in stage I NSCLC>1 to 2 cm. Multivariable analysis showed that segmentectomy had similar OS and LCSS compared with lobectomy in patients with stage I NSCLC ≤2 cm. Lymph node dissection (LND) was associated with better OS in patients with NSCLC ≤2 cm and better LCSS in patients with stage I NSCLC>1 to 2 cm. Conclusions Segmentectomy showed comparable survival compared with lobectomy in patients with stage I NSCLC ≤2 cm. LND can provide more accurate pathological stage, may affect survival, and should be recommended for above patients.

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Surgical Choice for Patients With Stage I Non-small-cell Lung Cancer ≤ 2 Cm: An Analysis From Surveillance, Epidemiology, and End Results Database

10.21203/rs.3.rs-31558/v1 ◽

2020 ◽

Author(s):

Weigang Zhao ◽

Tangbing Chen ◽

Yi Yang

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Surgical Procedure ◽

Wedge Resection ◽

Univariate Analysis ◽

Small Cell ◽

Stage I ◽

Small Cell Lung ◽

End Results

Abstract Background: No consensus was reached on the surgical procedure for patients with stage I non-small-cell lung cancer(NSCLC) ≤ 2 cm. The aim of this study isto investigate the appropriate surgical procedure forstage I NSCLC≤ 2 cm.Methods: Patients with stage I NSCLC ≤ 2 cm received wedge resection, segmentectomy, lobectomy between January 2004 andDecember 2015 were identified using the Surveillance, Epidemiology, and End Results(SEER) database. Data were stratified by age, gender, race, side, location, grade,histology, extent of lymphadenectomy. Overall survival (OS) and lung cancer-specific survival (LCSS) were compared among patients received wedge resection, segmentectomy, lobectomy. Univariate analysis and multivariable Cox regression were performed to identify the prognostic factors ofOS and LCSS. Results:A total of 16511 patients with stage I NSCLC ≤ 2 cm were included in this study, of whom 2945 patients were classified as stage I NSCLC ≤ 1cm.Lobectomy had better OS and LCSS when compared with wedge resection in patients with NSCLC ≤ 2 cm. Only OS favored lobectomy compared with segmentectomy in stage I NSCLC＞1 to 2 cm. Multivariable analysis showed thatsegmentectomy had similar OS and LCSScompared with lobectomy in patients with stage I NSCLC ≤ 2 cm. Lymph node dissection (LND) was associated with better OS in patients with NSCLC≤ 2 cm and better LCSS in patients with stage I NSCLC＞1 to 2 cm.Conclusions:Segmentectomy showed comparable survival compared with lobectomy in patients with stage I NSCLC ≤ 2 cm.LND can provide more accurate pathological stage, may affect survival, and should be recommended for above patients.

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