Segmentectomy Demonstrates Similar Survival And Recurrence Rates As Lobectomy For Early Stage Nsclc; A Seer Database Analysis
Mirza Zain Baig1, Joanna Weber1, Syed Shahzad Razi2, Cliff Connery3, Faiz Bhora3
1Nuvance Health, Danbury, CT, USA, 2Memorial Heathcare system, South Broward, FL, USA, 3Nuvance Health, Poughkeepsie, NY, USA
Background Recent evidence suggests that segmentectomy may be an adequate resection for peripheral early-stage non-small cell lung cancer (NSCLC) due to comparable overall survival with lobectomy. However, to date, few studies have focused specifically on recurrence after segmentectomy. We compared recurrence rates after segmentectomy and lobectomy in patients with NSCLC less than 2cm using a large population-based dataset.
Methods The Surveillance, Epidemiology and End Results (SEER) database was queried for patients with peripheral NSCLC less than 2 cm who underwent either lobectomy or segmentectomy between 2004 to 2012 without adjuvant/ neoadjuvant therapy. Patients with synchronous lung cancers (diagnosed within six months of the primary tumor) and metachronous lung cancers (tumors with different histology or discovered 48 months after diagnosis of primary cancer) were not included.
Results A total of 7174 patients met our inclusion criteria. The majority of the patients were white (86.6%) and female (60.5%). The average age at the time of diagnosis of the primary tumor was 65.38 (±10.51). Lobectomy and segmentectomy were performed in 6792 (94.7%) and 382 (5.3%) respectively. Between the two groups, there was no significant difference in median overall survival (152 vs 139 months, p=0.53). Thirteen (3.4%) patients in the segmentectomy group and 183 (2.7%) patients in the lobectomy group had tumor recurrence (p=0.41). Median time to recurrence in segmentectomy group was 36 months (95% CI: 18.39-53.62) whereas in the lobectomy group it was 31 months (95% CI: 28.16-33.84) [p = 0.85]. On multivariate analysis, there was no significant difference in recurrence rate for segmentectomy compared to lobectomy (HR: 1.33, 95% CI: 0.75-2.34) [p= 0.33]. Locoregional recurrence was found in 84.6% of the segmentectomy group and 90.2% of the lobectomy group (p=0.52).
Conclusion In our analysis of 7177 patients, we demonstrate that segmentectomy has similar survival outcomes and recurrence rates for peripheral early-stage NSCLC less than 2 cm. We also demonstrate the importance of close follow up for at least four years for timely diagnosis of late recurrences. Our results also suggest possible under utility of segmentectomy as only 5% of patients in our cohort underwent segmentectomy. However, more studies are needed to corroborate this finding.
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