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Comparison of outcomes following segmentectomy or lobectomy for patients with clinical N0 invasive lung adenocarcinoma of 2 cm or less in diameter

  • Original Article – Clinical Oncology
  • Published:
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Abstract

Purpose

Previous studies have reported similar survival between segmentectomy and lobectomy for patients with small-sized non-small cell lung cancer. However, part of those patients were with adenocarcinoma in situ or minimally invasive adenocarcinoma, which were considered to have a favorable prognosis. We compared survival outcomes of patients with clinical N0 invasive lung adenocarcinomas of no more than 2 cm who underwent segmentectomy or lobectomy.

Methods

Between June 1, 2008, and May 31, 2018, 1018 patients with clinical N0 invasive lung adenocarcinomas of no more than 2 cm in diameter on thin-section chest CT scans were retrospectively included in this study. Of them, 214 underwent segmentectomy and 804 underwent lobectomy. Propensity-score matching of preoperative factors, such as gender, age, smoking status, forced expiratory volume in 1 s predicted%, tumor’s CT appearance, tumor size on CT scan and tumor location was used to compare survival outcomes of those patients receiving different surgical treatments. Cox proportional hazard regression model was used to identify independent prognostic factors. This study was approved by the Committee for Ethical Review of Research (Fudan University Shanghai Cancer Center IRB# 090977–1). Informed consent was waived because of the retrospective nature of this study.

Results

Average follow-up time was 42.5 months. Before matching, the lobectomy group had a shorter recurrence-free survival (P = 0.02), but similar overall survival (P = 0.60). After matching, no significant difference of overall survival or recurrence-free survival was found between the two groups (P = 0.70 and P = 0.40, respectively).

Conclusions

Our results suggest that segmentectomy achieved similar recurrence-free and overall survival compared with lobectomy for patients with clinical N0 invasive lung adenocarcinomas of no more than 2 cm. Therefore, segmentectomy could be an alternative approach. These results need to be further validated by randomized trials.

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Funding

The study was supported by the National Natural Science Foundation of China (81930073), Shanghai Shenkang Hospital Development Center City Hospital Emerging Cutting-edge Technology Joint Research Project (SHDC12017102) and Shanghai Municipal Health Commission Key Discipline Project (2017ZZ02025 and 2017ZZ01019).

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Author notes

  1. Zhexu Wen, Yue Zhao and Fangqiu Fu contributed equally to this article.

Authors and Affiliations

  1. Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, 270 Dong-An Rd, Shanghai, 200032, China

    Zhexu Wen, Yue Zhao, Fangqiu Fu, Hong Hu, Yihua Sun, Yang Zhang & Haiquan Chen

  2. Institute of Thoracic Oncology, Fudan University, Shanghai, 200032, China

    Zhexu Wen, Yue Zhao, Fangqiu Fu, Hong Hu, Yihua Sun, Yang Zhang & Haiquan Chen

  3. State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, 200433, China

    Zhexu Wen, Yue Zhao, Fangqiu Fu, Hong Hu, Yihua Sun, Yang Zhang & Haiquan Chen

  4. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

    Zhexu Wen, Yue Zhao, Fangqiu Fu, Hong Hu, Yihua Sun, Yang Zhang & Haiquan Chen

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  1. Zhexu Wen
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  2. Yue Zhao
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Correspondence to Yang Zhang or Haiquan Chen.

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The authors declare that they have no competing interests.

Ethical approval

This study was approved by the Committee for Ethical Review of Research (Fudan University Shanghai Cancer Center IRB# 090977–1).

Informed consent

Informed consent was waived because of the retrospective nature of this study.

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Wen, Z., Zhao, Y., Fu, F. et al. Comparison of outcomes following segmentectomy or lobectomy for patients with clinical N0 invasive lung adenocarcinoma of 2 cm or less in diameter. J Cancer Res Clin Oncol 146, 1603–1613 (2020). https://doi.org/10.1007/s00432-020-03180-3

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  • DOI: https://doi.org/10.1007/s00432-020-03180-3

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