Lobectomy offers improved survival outcomes relative to segmentectomy for >2 but ≤4 cm non–small cell lung cancer tumorsCentral MessagePerspective
Terrance Peng, MD, MPH,
Sean C. Wightman, MD,
Li Ding, MD, MPH,
Dustin K. Lieu, MD,
Scott M. Atay, MD,
Elizabeth A. David, MD, MAS,
Anthony W. Kim, MD
Affiliations
Terrance Peng, MD, MPH
Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, Calif
Sean C. Wightman, MD
Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, Calif
Li Ding, MD, MPH
Department of Preventive Medicine, Keck School of Medicine of USC, Los Angeles, Calif
Dustin K. Lieu, MD
Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, Calif
Scott M. Atay, MD
Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, Calif
Elizabeth A. David, MD, MAS
Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, Calif
Anthony W. Kim, MD
Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, Los Angeles, Calif; Address for reprints: Anthony W. Kim, MD, Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of USC, 1510 San Pablo St, Suite 514, Los Angeles, CA 90033.
Objective: The objective was to compare overall survival (OS) between lobectomy and segmentectomy for patients with non–small cell lung cancers (NSCLCs) > 2 but ≤4 cm. Methods: The National Cancer Database was queried to identify treatment-naïve patients with NSCLC tumors >2 but ≤4 cm. Eligible patients were diagnosed with pT1 or T2 N0 M0 disease, underwent lobectomy or segmentectomy, and received no adjuvant therapy. OS was compared using the Kaplan-Meier method, and the Cox proportional-hazards model was used to identify prognostic factors for death. Propensity score matching was performed to minimize the effects of potential confounders. Results: Included were 32,792 patients: lobectomy (n = 31,353) and segmentectomy (n = 1439). Five-year OS was improved following lobectomy over segmentectomy for patients with >2 but ≤4 cm NSCLCs (62.3% vs 52.6%; P 2 but ≤3 cm (64.9% vs 54.3%; P 3 but ≤4 cm (56.9% vs 47.6%; P = .0003). In patients with a Charlson-Deyo comorbidity index of 0, 5-year OS was greater following lobectomy for >2 but ≤4 cm tumors (67.1% vs 62.1%; P = .03). Further stratification demonstrated improved 5-year OS following lobectomy for patients with Charlson-Deyo comorbidity index of 0 and > 3 but ≤4 cm tumors (61.8% vs 54.6%; P = .02). Segmentectomy was prognostic for increased risk of death in the year 1 through 5 postoperative period (hazard ratio, 1.35; P 2 but ≤4 cm when feasible.
