Evidence of Improved Survival for Lobectomy vs Limited Resection in Early-stage Lung Cancer

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Evidence is statistically inconclusive but suggestive that lobectomy, compared with limited resection, is associated with increased long-term survival for early-stage lung cancer,” according to a study reported in the Journal of the National Cancer Institute.

The study analyzed data from 679 patients diagnosed with stage I or II non–small cell lung cancer (NSCLC) in a variety of regions and hospitals in the United States. Patients were mostly elderly, male, and white, and more than 85% were current or former smokers. Most patients (524, or 77%) had lobectomy, but 155 (23%) had limited resection.

The authors noted that the while “lobectomy is considered the standard treatment for early-stage NSCLC,” the relatively high frequency of limited resection “likely reflects both the extent of comorbidity seen in patients with lung cancer and ongoing disagreement concerning the appropriate role for limited resection in the treatment of NSCLC.”

There was no difference in tumor histology between the two groups of patients and most patients in each group had adenocarcinoma. Patients in the limited resection group had greater severity of lung disease and were more likely to have a history of heart failure, stroke, and obesity. “Increasing severity of lung disease and a history of stroke were associated with receipt of limited resection, indicating that sublobar resections can serve as an alternative approach for those unable to tolerate lobectomy,” the authors noted.

Key Data

Patients were observed for a median of 55 months. “Over the course of the study, a non-statistically significant trend toward improved long-term survival was evident for lobectomy, compared with limited resection, in adjusted analyses (hazard ratio of death = 1.35 for limited resection, 95% CI = 0.99 to 1.84, P = .05),” the researchers reported.

A survey of physicians identified by study patients found that the surgeons of patients in the limited resection group “tended more often to be thoracic surgeons compared with surgeons of patients in the lobectomy group (81% vs 72%, P = .09) and they tended to perform a higher number of lung resections per month” (median = 6 vs 4, P = .07). Other factors reported to be independently associated in adjusted analysis with limited resection were “Medicare, Medicaid, lack of or unknown type of insurance, small tumor size, increasing severity of lung disease, and history of stroke.” ■

Billmeier SE, et al: J Natl Cancer Inst 103:1621-1629, 2011.