SESSION TYPE: Thoracic Surgery II
PRESENTED ON: Tuesday, October 23, 2012 at 04:30 PM - 05:45 PM
PURPOSE: Since the randomized controlled study of sublobar resection vs. lobectomy for stage I NSCLCs by the Lung Cancer Study Group (LCSG), there have been improvements in staging. Also, the liberal use of computerized tomography may have altered the types of early lung cancer diagnosed. Studies published since then have drawn contradictory conclusions on the benefit of lobectomy over sublobar resections for early stage NSCLC. We examined the SEER database to assess the influence of these evolving factors on the relationship between the extent of resection and survival over the last two decades.
METHODS: Stage I NSCLCs < 2cm in size were examined over three time periods: 1988 - 1998 (Early), 1999 - 2004 (Intermediate) and 2005 - 2008 (Late). For each period, overall and disease-specific survival and their association with extent of resection was assessed by univariate and multivariate analyses. Sublobar resections in the ”Early” group could not be categorized into segmentectomies and wedge resections as these were not coded separately.
RESULTS: The proportion of NSCLCs < 2cm increased from 0.98% in 1988 to 2.2% in 2008. Multivariate analyses showed that sublobar resection was inferior to lobectomy in the “Early” period (HR=1.41; 95%CI=1.21-1.65). This effect decreased in the “Intermediate” period where segmentectomies but not wedge resections were equivalent to lobectomies (Wedge vs. Lobectomy HR = 1.19; 95%CI=1.01 - 1.41; Segmentectomy vs. Lobectomy HR =1.04; 95%CI=0.8-1.36). The difference disappeared in the “Late” period where both wedge resections and segmentectomies were equivalent to lobectomy(Wedge vs. Lobectomy HR = 1.09; 95%CI=0.79 - 1.5; Segmentectomy vs. Lobectomy HR =0.83; 95%CI=0.47-1.45). The trends for both overall survival and disease specific survival were identical.
CONCLUSIONS: The survival benefit of lobectomy over sublobar resection decreased over the last two decades with no discernible difference in the most contemporary cases.
CLINICAL IMPLICATIONS: These results support the hypothesis that better staging and earlier detection of less aggressive disease due to the expanding use of computerized tomography and PET/CT may make the results of the LCSG irrelevant to current clinical practice.
DISCLOSURE: The following authors have nothing to disclose: Sai Yendamuri, Rohit Sharma, Adrienne Groman, Austin Miller, Todd Demmy
No Product/Research Disclosure InformationRoswell Park Cancer Institute, Buffalo, NY