Extent of Resection Influences Survival in Early-Stage Lung Cancer with Occult Nodal Disease.
Academic Article
Overview
abstract
BACKGROUND: Minimal literature exists evaluating the impact of the extent of resection on survival in patients with small, early-stage non-small cell lung cancer (NSCLC) found to have occult nodal disease (OND). We hypothesized that sublobar resection has comparable overall survival to patients undergoing lobectomy for clinical Stage IA NSCLC that harbors OND. METHODS: The National Cancer Database was reviewed for identification of patients with clinical Stage IA NSCLC who underwent wedge resection, segmentectomy or lobectomy and were found to have OND. Overall survival was compared between groups and a multivariate Cox-Regression model identified factors associated with worse survival. RESULTS: OND occurred in 6.1% of all patients with clinical Stage IA disease undergoing resection. Patients undergoing wedge resection and segmentectomy found to have OND were older (67.6 ± 9.6 vs. 66.1 ± 9.3 vs. 65.6 ± 9.5, p=0.004), and had more advanced pathologic stage (pStage III: 68.7% vs. 50.5% vs. 41.5%, p<0.001) than those receiving lobectomy. There was no difference in the median overall survival between segmentectomy and lobectomy (68.5 months vs. 57.6, p=0.200.) However, wedge resection was independently associated with worse overall survival when controlling for other preoperative variables, hazard ratio: 1.23 (1.01 - 1.51), p=0.042. CONCLUSIONS: Review of the National Cancer Database suggests that there is no improvement in overall survival in patients undergoing lobectomy versus segmentectomy in carefully selected patients with clinical Stage IA NSCLC harboring occult nodal disease. However, those undergoing wedge resection may have worse overall survival than those undergoing both lobectomy and segmentectomy.
