A Comparison Of Segmentectomy And Lobectomy In Stage Ia Adenocarcinomas >1 And ≤2 Cm
Ze-Rui Zhao1, Dong-Rong Situ2, Rainbow W.H. Lau1, Tony S.K. Mok1, George G. Chen1, Malcolm J. Underwood1, Malcolm J. Underwood1, Calvin S.H. Ng1.
1Chinese University of Hong Kong, Hong Kong, Hong Kong, 2Sun Yat-Sen University Cancer Centre, Guangzhou, China.
OBJECTIVE: Recent studies have suggested that segmentectomy may be an acceptable alternative treatment to lobectomy, for surgical management of smaller lung adenocarcinomas. The objective of this study was to compare survival after lobectomy and segmentectomy among patients with pathological stage IA adenocarcinoma categorized as the new T1b (>10 to ≤20 mm) according to the eighth TNM system.
METHODS: In total, 7,989 patients were identified from the Surveillance, Epidemiology, and End Results registry. Propensity scores, generated from logistic regression on preoperative characteristics, were used to balance the selection bias of undergoing segmentectomy. Overall and lung cancer-specific survival of patients undergoing segmentectomy and lobectomy were compared in propensity score-matched groups.
RESULTS: Overall, 564 (7.1%) patients underwent segmentectomy. Lobectomy led to better overall and lung cancer-specific survival than segmentectomy for the entire cohort (log-rank P<0.01). After 1:2 propensity score matching, segmentectomy (n=552) was no longer associated with significant worse overall (5-year survival: 74.45% versus 76.67%, hazard ratio: 1.09, 95% confidence interval: 0.90-1.33) or lung cancer-specific (5-year survival: 83.89% versus 86.11%, hazard ratio: 1.12, 95% confidence interval: 0.86-1.46) survival compared with lobectomy (n=1,085) after adjusting for age, sex, lymph node quantity, and histology. Similar negative findings were identified when stratifying patients according to sex, age, histology, and number of evaluated lymph nodes.
CONCLUSIONS: Segmentectomy may have survival outcomes not different than some patients who received lobectomy for pathological stage IA adenocarcinomas that are >10 and ≤20 mm in size. These results should be further confirmed via prospective randomised trials.
Survival curves adjusted for age, sex, histology, and lymph node quantity compare treatment with segmentectomy versus lobectomy in patients with pathological stage IA adenocarcinoma (>10 and ≤20 mm) after propensity scores matching for (A) overall and (B) lung cancer-specific survival. The shaded area represents the confidence limits for each group.
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