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A Propensity-matched Study of Lobectomy Versus Segmentectomy for Radiologically Pure Solid Small-sized Non-small Cell Lung Cancer
Terumoto Koike1, Seijiro Sato1, Takehisa Hashimoto1,Tadashi Aoki2, Teruaki Koike2, Katsuo Yoshiya2, Shin-ichi Toyabe3,
Masanori Tsuchida1
1 Division of Thoracic and Cardiovascular Surgery, Niigata University, Niigata, Japan2 Division of Chest Surgery, Niigata Cancer Center Hospital, Niigata, Japan3 Niigata University Crisis Management Office, Niigata University Hospital, Niigata, Japan
Relevant Financial Relationship Disclosure Statement
The authors have no conflicts of interest to declare.
BACKGROUND
1. Lobectomy has been performed as a standard surgical procedure for non-small cell lung cancer (NSCLC) patients.
2. In NSCLC patients with a large proportion of ground-glass opacity (GGO) component on CT, excellent surgical outcomes after limited resection were demonstrated.
3. Indications for limited resection for NSCLC patients with radiologically pure solid tumors remain controversial.
OBJECTIVE
To compare postoperative outcomes after lobectomy and segmentectomy in patients with small radiologically pure solid NSCLC.
METHODS (1)
Patients
Inclusion Criteria:1. cT1a N0 M0 NSCLC (≤2 cm)2. Radiologically “pure solid” appearance3. Peripheral location4. Underwent lobectomy or segmentectomy in 1998—
20095. Complete resection
1. Preoperative characteristics werematched using propensity score methods.2. Overall survival (OS) and disease-free survival (DFS) were evaluatedby the log-rank test and McNemar test.3. The preoperative factors and surgical procedure were
analyzed with a multivariate analysis for OS and DFS.
METHODS (2)
AnalysisRadiologically Pure Solid cT1a
N0 M0 NSCLC Patients (n = 251)
Lobectomy(n = 151)
Segmentectomy(n = 100)
Lobectomy(n = 87)
Segmentectomy(n = 87)
Propensity Score—Matching
RESULTS
Post-adjustment Preoperative Characteristics of the Patients with Radiologically Pure Solid cT1a N0 M0 NSCLC
Characteristic Lobectomy Segmentectomy P value
All cases, n 87 87
Age [y], median (range) 68 (37–81) 68 (42–83) .399
Sex, n (%) Male 48 (55) 51 (59) .760
Female 39 (45) 36 (41)
Smoking index, median (range) 500 (0–2200) 500 (0–2400) .809
Percent predicted VC [%], median (range) 114 (67–156) 114 (57–152) .897
FEV1/FVC ratio [%], median (range) 73 (43–96) 75 (40–89) .620
Preoperative CEA [ng/ml], median (range) 2.8 (0.1–25) 2.8 (0.5–18) .441
Radiological tumor size [cm], median (range) 1.6 (0.8–2.0) 1.6 (0.6–2.0) .919
Tumor histology, n (%) Ad
Sq
Others
68 (78) 70 (80) .915
14 (16) 13 (15)
5 (6) 4 (5)
Overall Survival Curves for Patients in Propensity Score–Matched Lobectomy and Segmentectomy Groups
0 5 10 150
20
40
60
80
100
Lobectomy (n = 87)
Segmentectomy (n = 87)
Years from resection
Ove
rall
s ur v
iva l
[%
]
Patients at riskLobectomySegmentectomy
8787
8381
5848
4134
297
130
10
85.2%
75.4% 65.5%84.2%
80.4%
63.1%
p = 0.767
Disease-free Survival Curves for Patients in Propensity Score–Matched Lobectomy and Segmentectomy Groups
0 5 10 150
20
40
60
80
100
Lobectomy (n = 87)Segmentectomy (n = 87)
Years from resection
Dis
ease
-fre
e s u
rviv
a l [%
]
Patients at riskLobectomySegmentectomy
8787
7674
5544
4031
297
130
10
80.0%
71.7% 63.8%76.9%73.1%
58.0%
p = 0.635
Outcomes of Segmentectomy Compared to Lobectomy for Propensity Score–Matched Pairs of the Patients
Overall Survival, n (%)
Survival Interval Lobectomy Segmentectomy OR (95% CI) P Value
3-year 74 (91.4) 73 (90.1) 1.143 (0.362–3.702) 1.000
5-year 44 (88.0) 40 (80.0) 1.800 (0.542–6.837) .424
7-year 28 (77.8) 28 (77.8) 1.000 (0.299–3.341) 1.000
Disease-free Survival, n (%)
Survival Interval Lobectomy Segmentectomy OR (95% CI) P Value
3-year 68 (84.0) 69 (85.2) 0.923 (0.385–2.194) 1.000
5-year 43 (82.7) 39 (75.0) 1.500 (0.564–4.230) .503
7-year 28 (71.8) 27 (69.2) 1.111 (0.406–3.090) 1.000
Multivariate Cox Proportional Hazard Analysis of OS and DFS for the 174 Propensity Score–Matched Patients
Overall Survival Disease-free Survival
Variable HR 95% CI P Value HR 95% CI P Value
Age [years] 1.063 1.025–1.103 .001 1.040 1.008–1.074 .015
Smoking status (Brinkman Index) 1.001 1.000–1.001 .001 1.001 1.000–1.001 <.001
FEV1/FVC ratio [%] 1.065 1.027–1.104 .001 1.058 1.024–1.093 .001
Preoperative serum CEA [ng/ml] 1.100 1.015–1.193 .021 1.084 1.010–1.164 .024
Segmentectomy was not a significant independent predictor of poor OS or DFS
CONCLUSIONS
Postoperative outcomes of radiologically pure solid small NSCLC patients were compared in propensity score–matched lobectomy and segmentectomy groups.
Oncological outcomes were similar after lobectomy and segmentectomy.
Even for patients with radiologically pure solid NSCLC, outcomes of segmentectomy may be non-inferior.