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Limited Resection Not Equivalent to Lobectomy for Survival in Older Patients With Early-Stage Lung Cancer

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Key Points

  • Overall, limited resection was not equivalent to lobectomy in overall survival or cancer-specific survival in patients with adenocarcinoma or squamous cell carcinoma.
  • Segmentectomy was associated with overall survival similar to lobectomy in patients with adenocarcinoma.

In an analysis reported in the Journal of Clinical Oncology, Veluswamy et al found that limited resection was not equivalent to lobectomy in overall survival among older patients with stage IA invasive adenocarcinoma or squamous cell carcinoma of the lung. Among patients with adenocarcinoma, segmentectomy, but not wedge resection, appeared to have outcomes similar to lobectomy.

Study Details

The study involved data from patients aged > 65 years with stage IA invasive adenocarcinoma or squamous cell carcinoma ≤ 2 cm who received limited resection (wedge or segmentectomy) or lobectomy in the Surveillance, Epidemiology, and End Results–Medicare data base. Propensity scoring was used to predict the use of limited resection. Treatments were considered equivalent if the upper 95th percentile of the hazard ratio (HR) for limited resection was ≤ 1.25.

No Overall Equivalence

Overall, 27% of 2,008 patients with adenocarcinoma and 32% of 1,139 patients with squamous cell carcinoma underwent limited resection. Analysis adjusting for propensity scores showed that limited resection was not equivalent to lobectomy in overall survival (HR = 1.21, upper 95% confidence interval [CI] = 1.34) or lung cancer–specific survival (HR = 1.66, upper 95% CI = 1.96) among patients with adenocarcinoma or in overall survival (HR = 1.21, upper 95% CI = 1.39) or lung cancer–specific survival (HR = 1.41, upper 95% CI = 1.79) among those with squamous cell carcinoma.

Type of Limited Resection

Patients with adenocarcinoma treated with segmentectomy had equivalent overall survival vs those treated with lobectomy (HR = 0.97, upper 95% CI = 1.07), whereas those treated with wedge resection did not (HR = 1.29, upper 95% CI = 1.42). Wedge resection (HR = 1.34, upper 95% CI = 1.53) and segmentectomy (HR = 1.19, upper 95% CI = 1.36) were not equivalent to lobectomy in patients with squamous cell carcinoma.

The investigators concluded: “We found generally that limited resection is not equivalent to lobectomy in older patients with invasive non–small-cell lung cancer ≤ 2 cm in size, although segmentectomy may be equivalent in patients with adenocarcinoma.”

Rajwanth R. Veluswamy, MD, of Icahn School of Medicine at Mount Sinai, is the corresponding author for the Journal of Clinical Oncology article.

The study was supported by the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality. For full disclosures of the study authors, visit jco.ascopubs.org.

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®.


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