Lobectomy, segmentectomy or wedge resection for peripheral clinical T1aN0 non-small cell lung cancer: a post-hoc analysis of CALGB 140503 (Alliance).
Academic Article
Overview
abstract
OBJECTIVE: We have recently reported the primary results of CALGB 140503 (Alliance), a randomized trial in patients with peripheral cT1aN0 NSCLC (AJCC 7th) treated with either lobar (LR) or sublobar resection (SLR). Here we report differences in disease-free survival (DFS), overall survival (OS) and lung cancer specific survival (LCSS) between LR, segmental (SR) and wedge resections (WR). We also report differences between WR and SR in surgical margins, rates of locoregional recurrence (LRR) and expiratory flow rates at 6 months postoperatively. METHODS: Between 6/2007 and 3/2017, 697 patients were randomized to LR (357) or SLR (340) stratified by clinical tumor size, histology and smoking history. Ten patients were converted from SLR to LR and 5 from LR to SLR. Survival end points were estimated by the Kaplan-Meier estimator and tested by the stratified Log rank test. Kruskal-Wallis testing was used to compare margins and FEV1 changes between groups; and a Chi-square test was used to test the association between recurrence and groups. RESULTS: A total of 362 patients had LR, 131 had SR and 204 had WR. Basic demographic and clinical and pathological characteristics were similar between all three groups. Five-year DFS was 64.7% after LR [95% CI; 59.6-70.1%], 63.8% after SR [ 95% C; 55.6 - 73.2%] and 62.5% after WR [95% CI; 55.8 - 69.9%] (Log rank, p = 0.888). Five-year OS was 78.7% after LR, 81.9% after SR and 79.7% after WR (Log rank, p = 0.873). Five-year LCSS was 86.8% after LR, 89.2% after SR and 89.7% after WR (Log rank, p = 0.903). LRR occurred in 12% after SR and 14% after WR (p=0.295). At 6 months postoperatively, the median reduction in % FEV1 was 5% after WR and 3% after SR (p=0.930) CONCLUSIONS: In this large, randomized trial, LR, SR and WR were associated with similar survival outcomes. Although LRR was numerically higher after WR compared to SR, the difference was not clinically meaningful statistically significant. There was no significant difference in the reduction of FEV1 between the SR and WR groups.
