Propensity-Matched Analysis Shows Similar Outcomes for Segmentectomy vs Lobectomy in Stage I NSCLC
Recent retrospective, single-institution analyses have suggested that anatomic segmentectomy results in freedom from recurrence and survival rates similar to those achieved by lobectomy in lung cancer. In a large propensity-matched analysis reported in the Journal of Clinical Oncology, Landreneau and colleagues found no significant differences between segmentectomy and lobectomy in recurrence rates or overall survival in patients with clinical stage I non–small cell lung cancer (NSCLC), although outcomes tended to favor lobectomy.
Study Details
The retrospective analysis included matched segmentectomy and lobectomy cohorts (n = 312 in each) generated using data from 392 segmentectomy patients and 800 lobectomy patients from the University of Pittsburgh Lung Cancer Database. Matching was accomplished using a propensity score matching algorithm that accounted for the confounding effects of preoperative patient variables identified by logistic regression. The primary outcome measures were freedom from recurrence and overall survival.
Reflecting matching, the segmentectomy and lobectomy cohorts were well balanced for age (median, 68 years in both), sex (55% and 54% female), comorbidities (hypertension in 53% and 49%, diabetes in 18% and 14%, chronic obstructive pulmonary disease in 33% and 34%, previous cancer in 25% and 23%), smoking status (93% ever in both), FEV1 (mean 78% and 75%), histology (adenocarcinoma in 57% and 59%), tumor size (mean, 2.2 cm in both), and tumor stage (IA in 79% and 77%).
Recurrence and Survival Outcomes
Perioperative mortality was 1.2% in the segmentectomy group and 2.5% in the lobectomy group (P = .38). At a mean follow-up of 5.4 years, there were no differences between the segmentectomy and lobectomy groups in locoregional (5.5% vs 5.1%, P = 1.00), distant (14.8% vs 11.6%, P = .29), or overall recurrence rates (20.2% vs16.7%, P = .30). No significant differences in time to recurrence were found among patients with T1a (P = .585), T1b (P = .395), or T2a tumors (P =.432).
There were no differences between groups in Kaplan-Meier estimates of 5-year freedom from recurrence (70% vs 71%, P = .467) or overall survival (54% vs 60%, P = .258). Segmentectomy was not an independent predictor of recurrence (hazard ratio [HR] = 1.11, 95% confidence interval [CI] = 0.87–1.40) or overall survival (HR = 1.17, 95% CI = 0.89–1.52).
The investigators concluded, “In this large propensity-matched comparison, lobectomy was associated with modestly increased freedom from recurrence and overall survival, but the differences were not statistically significant. These results will need further validation by prospective, randomized trials (eg, Cancer and Leukemia Group B 140503 trial).”
Rodney J. Landreneau, MD, of University of Pittsburgh Medical Center, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by grants from the National Heart, Lung, and Blood Institute and National Cancer Institute. Neil A. Christie, MD, reported a consultant or advisory role with Varian. James D. Luketich, MD, reported research funding from Accuray.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
