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Original Research: LUNG CANCER |

Survival Following Lobectomy and Limited Resection for the Treatment of Stage I Non-small Cell Lung Cancer ≤ 1 cm in Size: A Review of SEER Data

Max Kates, BA; Scott Swanson, MD; Juan P. Wisnivesky, MD, DrPH
Author and Funding Information

From the Mount Sinai School of Medicine (Mr Kates) and the Divisions of General Internal Medicine and Pulmonary, Critical Care, and Sleep Medicine (Dr Wisnivesky), Mount Sinai School of Medicine, New York, NY; and the Division of Thoracic Surgery (Dr Swanson), Brigham and Women’s Hospital, Boston, MA.

Correspondence to: Juan P. Wisnivesky, MD, DrPH, Department of Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1087, New York, NY 10029; e-mail: juan.wisnivesky@mssm.edu


For editorial comment see page 481.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(3):491-496. doi:10.1378/chest.09-2547
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Background:  Although lobectomy is the standard treatment for stage I non-small cell lung cancer (NSCLC), recent studies have suggested that limited resection may be a viable alternative for small-sized tumors. The objective of this study was to compare survival after lobectomy and limited resection among patients with stage IA tumors ≤ 1 cm by using a large, US-based cancer registry.

Methods:  Using the Surveillance, Epidemiology, and End Results (SEER) registry, we identified 2,090 patients with stage I NSCLC ≤ 1 cm in size who underwent lobectomy or limited resection (segmentectomy or wedge resection). We used propensity score analysis to adjust for potential differences in the baseline characteristics of patients in the two treatment groups. Overall and lung cancer-specific survival rates of patients undergoing lobectomy vs limited resection were compared in stratified and adjusted analyses, controlling for propensity scores.

Results:  Overall, 688 (33%) patients underwent limited resection. For the entire cohort, we were not able to identify a difference in outcomes among patients treated with lobectomy vs limited resection, as demonstrated by an adjusted hazard ratio (HR) for overall survival (1.12; 95% CI, 0.93-1.35) and lung cancer-specific survival (HR, 1.24; 95% CI, 0.95-1.61). Similarly, when the cohort was divided into propensity score quintiles, we did not find a difference in survival rate between the two groups.

Conclusions:  Limited resection and lobectomy may lead to equivalent survival rates among patients with stage I NSCLC tumors ≤ 1 cm in size. If confirmed in prospective studies, limited resection may be preferable for the treatment of small tumors because it may be associated with fewer complications and better postoperative lung function.


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