Skip to main content

Advertisement

SpringerLink
Log in

Propensity-Matched Analysis Comparing Survival After Sublobar Resection and Lobectomy for cT1N0 Lung Adenocarcinoma

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The optimal surgical method for cT1N0 lung adenocarcinoma remains controversial.

Objective

The aim of this study was to evaluate the differences in clinical outcomes of sublobar resection and lobectomy for cT1N0 lung adenocarcinoma patients.

Methods

We included 1035 consecutive patients with cT1N0 lung adenocarcinoma who underwent surgery at our institute from January 2011 to December 2016. The surgical approach, either sublobar resection or lobectomy, was determined at the discretion of each surgeon. A propensity-matched analysis incorporating total tumor diameter, solid component diameter, consolidation-to-tumor (C/T) ratio, and performance status was used to compare the clinical outcomes of the sublobar resection and lobectomy groups.

Results

Sublobar resection and lobectomy were performed for 604 (58.4%; wedge resection/segmentectomy: 470/134) and 431 (41.6%) patients, respectively. Patients in the sublobar resection group had smaller total tumor diameters, smaller solid component diameters, lower C/T ratios, and better performance status. More lymph nodes were dissected in the lobectomy group. Patients in the sublobar resection group had better perioperative outcomes. A multivariable analysis revealed that the solid component diameter and serum carcinoembryonic antigen level are independent risk factors for tumor recurrence. After propensity matching, 284 paired patients in each group were included. No differences in overall survival (OS; p = 0.424) or disease-free survival (DFS; p = 0.296) were noted between the two matched groups.

Conclusions

Sublobar resection is not inferior to lobectomy regarding both DFS and OS for cT1N0 lung adenocarcinoma patients. Sublobar resection may be a feasible surgical method for cT1N0 lung adenocarcinoma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. 1995;60:615–22 (discussion 22-3).

    Article  CAS  PubMed  Google Scholar 

  2. Speicher PJ, Gu L, Gulack BC, et al. Sublobar resection for clinical stage IA non-small-cell lung cancer in the United States. Clin Lung Cancer. 2016;17:47–55.

    PubMed  Google Scholar 

  3. Kates M, Swanson S, Wisnivesky JP. Survival following lobectomy and limited resection for the treatment of stage I non-small cell lung cancer ≤ 1 cm in size: a review of SEER data. Chest. 2011;139:491–6.

    PubMed  Google Scholar 

  4. Whitson BA, Groth SS, Andrade RS, et al. Invasive adenocarcinoma with bronchoalveolar features: a population-based evaluation of the extent of resection in bronchoalveolar cell carcinoma. J Thorac Cardiovasc Surg. 2012;143:591–600.

    PubMed  Google Scholar 

  5. Yendamuri S, Sharma R, Demmy M, et al. Temporal trends in outcomes following sublobar and lobar resections for small (≤ 2 cm) non-small cell lung cancers: a surveillance epidemiology end results database analysis. J Surg Res. 2013;183:27–32.

    PubMed  Google Scholar 

  6. Harada H, Okada M, Sakamoto T, et al. Functional advantage after radical segmentectomy versus lobectomy for lung cancer. Ann Thorac Surg. 2005;80:2041–5.

    PubMed  Google Scholar 

  7. McMurry TL, Shah PM, Samson P, et al. Treatment of stage I non-small cell lung cancer: what’s trending? J Thorac Cardiovasc Surg. 2017;154:1080–7.

    PubMed  Google Scholar 

  8. Hu SY, Hsieh MS, Hsu HH, et al. Correlation of tumor spread through air spaces and clinicopathological characteristics in surgically resected lung adenocarcinomas. Lung Cancer. 2018;126:189–93.

    PubMed  Google Scholar 

  9. Lin MW, Huang YL, Yang CY, et al. The differences in clinicopathologic and prognostic characteristics between surgically resected peripheral and central lung squamous cell carcinoma. Ann Surg Oncol. 2019;26:217–29.

    PubMed  Google Scholar 

  10. Bai JH, Hsieh MS, Liao HC, et al. Prediction of pleural invasion using different imaging tools in non-small cell lung cancer. Ann Transl Med. 2019;7:33.

    PubMed  PubMed Central  Google Scholar 

  11. Lee PN, Forey BA, Coombs KJ, et al. Time trends in never smokers in the relative frequency of the different histological types of lung cancer, in particular adenocarcinoma. Regul Toxicol Pharmacol. 2016;74:12–22.

    PubMed  Google Scholar 

  12. Rami-Porta R, Asamura H, Travis WD, Rusch VW. Lung cancer—major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017;67:138–55.

    PubMed  Google Scholar 

  13. Suzuki K, Koike T, Asakawa T, et al. A prospective radiological study of thin-section computed tomography to predict pathological noninvasiveness in peripheral clinical IA lung cancer (Japan Clinical Oncology Group 0201). J Thorac Oncol. 2011;6:751–6.

    PubMed  Google Scholar 

  14. Travis WD, Brambilla E, Nicholson AG, et al. The 2015 World Health Organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification. J Thorac Oncol. 2015;10:1243–60.

    PubMed  Google Scholar 

  15. Hung WT, Hung MH, Wang ML, et al. Nonintubated thoracoscopic surgery for lung tumor: seven years’ experience with 1,025 cases. Ann Thorac Surg. 2019;107(6):1607–12.

    PubMed  Google Scholar 

  16. Fiorelli A, Caronia FP, Daddi N, et al. Sublobar resection versus lobectomy for stage I non-small cell lung cancer: an appropriate choice in elderly patients? Surg Today. 2016;46:1370–82.

    PubMed  Google Scholar 

  17. Gu C, Wang R, Pan X, et al. Sublobar resection versus lobectomy in patients aged ≤ 35 years with stage IA non-small cell lung cancer: a SEER database analysis. J Cancer Res Clin Oncol. 2017;143:2375–82.

    PubMed  Google Scholar 

  18. Khullar OV, Liu Y, Gillespie T, et al. Survival after sublobar resection versus lobectomy for clinical stage IA lung cancer: an analysis from the national cancer data base. J Thorac Oncol. 2015;10:1625–33.

    PubMed  PubMed Central  Google Scholar 

  19. Kodama K, Higashiyama M, Okami J, et al. Oncologic outcomes of segmentectomy versus lobectomy for clinical T1a N0 M0 non-small cell lung cancer. Ann Thorac Surg. 2016;101:504–11.

    PubMed  Google Scholar 

  20. Koike T, Kitahara A, Sato S, et al. Lobectomy versus segmentectomy in radiologically pure solid small-sized non-small cell lung cancer. Ann Thorac Surg. 2016;101:1354–60.

    PubMed  Google Scholar 

  21. Tsutani Y, Miyata Y, Nakayama H, et al. Oncologic outcomes of segmentectomy compared with lobectomy for clinical stage IA lung adenocarcinoma: propensity score-matched analysis in a multicenter study. J Thorac Cardiovasc Surg. 2013;146:358–64.

    PubMed  Google Scholar 

  22. Dziedzic DA, Rudzinski P, Langfort R, et al. Risk factors for local and distant recurrence after surgical treatment in patients with non-small-cell lung cancer. Clin Lung Cancer. 2016;17:157–67.

    Google Scholar 

  23. Mery CM, Pappas AN, Bueno R, et al. Similar long-term survival of elderly patients with non-small cell lung cancer treated with lobectomy or wedge resection within the surveillance, epidemiology, and end results database. Chest. 2005;128:237–45.

    PubMed  Google Scholar 

  24. Tsutani Y, Mimura T, Kai Y, et al. Outcomes after lobar versus sublobar resection for clinical stage I non-small cell lung cancer in patients with interstitial lung disease. J Thorac Cardiovasc Surg. 2017;154:1089–96.

    PubMed  Google Scholar 

  25. Wisnivesky JP, Henschke CI, Swanson S, et al. Limited resection for the treatment of patients with stage IA lung cancer. Ann Surg. 2010;251:550–4.

    PubMed  Google Scholar 

  26. Koike T, Yamato Y, Yoshiya K, et al. Intentional limited pulmonary resection for peripheral T1 N0 M0 small-sized lung cancer. J Thorac Cardiovasc Surg. 2003;125:924–8.

    PubMed  Google Scholar 

  27. Warren WH, Faber LP. Segmentectomy versus lobectomy in patients with stage I pulmonary carcinoma. Five-year survival and patterns of intrathoracic recurrence. J Thorac Cardiovasc Surg. 1994;107:1087–93 (discussion 93-94).

    CAS  PubMed  Google Scholar 

  28. Keenan RJ, Landreneau RJ, Maley RH, et al. Segmental resection spares pulmonary function in patients with stage I lung cancer. Ann Thorac Surg. 2004;78:228–33 (discussion 228-33).

    PubMed  Google Scholar 

  29. Kodama K, Doi O, Higashiyama M, Yokouchi H. Intentional limited resection for selected patients with T1 N0 M0 non-small-cell lung cancer: a single-institution study. J Thorac Cardiovasc Surg. 1997;114:347–53.

    CAS  PubMed  Google Scholar 

  30. Subramanian M, McMurry T, Meyers BF, et al. Long-term results for clinical stage IA lung cancer-comparing lobectomy and sublobar resection. Ann Thorac Surg. 2018;106:375–81.

    PubMed  PubMed Central  Google Scholar 

  31. Grills IS, Mangona VS, Welsh R, et al. Outcomes after stereotactic lung radiotherapy or wedge resection for stage I non-small-cell lung cancer. J Clin Oncol. 2010;28:928–35.

    PubMed  Google Scholar 

  32. Wolf AS, Swanson SJ, Yip R, et al. The impact of margins on outcomes after wedge resection for stage I non-small cell lung cancer. Ann Thorac Surg. 2017;104:1171–8.

    PubMed  Google Scholar 

  33. Passlick B, Kubuschock B, Sienel W, et al. Mediastinal lymphadenectomy in non-small cell lung cancer: effectiveness in patients with or without nodal micrometastases—results of a preliminary study. Eur J Cardiothorac Surg. 2002;21:520–6.

    CAS  PubMed  Google Scholar 

  34. Keller SM, Adak S, Wagner H, et al. Mediastinal lymph node dissection improves survival in patients with stages II and IIIa non-small cell lung cancer. Eastern Cooperative Oncology Group. Ann Thorac Surg. 2000;70:358–65 (discussion 65-66).

    CAS  PubMed  Google Scholar 

  35. Darling GE, Allen MS, Decker PA, et al. Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: results of the American College of Surgery Oncology Group Z0030 Trial. J Thorac Cardiovasc Surg. 2011;141:662–70.

    PubMed  PubMed Central  Google Scholar 

  36. Flores RM, Nicastri D, Bauer T, et al. Computed tomography screening for lung cancer: mediastinal lymph node resection in stage IA nonsmall cell lung cancer manifesting as subsolid and solid nodules. Ann Surg. 2017;265:1025–33.

    PubMed  Google Scholar 

  37. Yendamuri S, Dhillon SS, Groman A, et al. Effect of the number of lymph nodes examined on the survival of patients with stage I non-small cell lung cancer who undergo sublobar resection. J Thorac Cardiovasc Surg. 2018;156:394–402.

    PubMed  Google Scholar 

  38. Huang X, Wang J, Chen Q, et al. Mediastinal lymph node dissection versus mediastinal lymph node sampling for early stage non-small cell lung cancer: a systematic review and meta-analysis. PLoS ONE. 2014;9:e109979.

    PubMed  PubMed Central  Google Scholar 

  39. Saji H, Matsubayashi J, Akata S, et al. Correlation between whole tumor size and solid component size on high-resolution computed tomography in the prediction of the degree of pathologic malignancy and the prognostic outcome in primary lung adenocarcinoma. Acta Radiol. 2015;56:1187–95.

    PubMed  Google Scholar 

  40. Kamiya S, Iwano S, Umakoshi H, et al. Computer-aided volumetry of part-solid lung cancers by using CT: solid component size predicts prognosis. Radiology. 2018;287:1030–40.

    PubMed  Google Scholar 

  41. Maeda R, Yoshida J, Ishii G, et al. Risk factors for tumor recurrence in patients with early-stage (stage I and II) non-small cell lung cancer: patient selection criteria for adjuvant chemotherapy according to the seventh edition TNM classification. Chest. 2011;140:1494–502.

  42. Rice TW, Blackstone EH, Rusch VW. 7th edition of the AJCC cancer staging manual: esophagus and esophagogastric junction. Ann Surg Oncol. 2010;17:1721–4.

    PubMed  Google Scholar 

  43. Wang S, Zhang B, Qian J, et al. Proposal on incorporating lymphovascular invasion as a T-descriptor for stage I lung cancer. Lung Cancer. 2018;125:245–52.

    CAS  PubMed  Google Scholar 

  44. Nakagawa K, Watanabe SI, Kunitoh H, et al. The Lung Cancer Surgical Study Group of the Japan Clinical Oncology Group: past activities, current status and future direction. Jpn J Clin Oncol. 2017;47:194–9.

    PubMed  Google Scholar 

  45. Kent MS, Mandrekar SJ, Landreneau R, et al. A Nomogram to predict recurrence and survival of high-risk patients undergoing sublobar resection for lung cancer: an analysis of a multicenter prospective study (ACOSOG Z4032). Ann Thorac Surg. 2016;102:239–46.

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgment

This study was supported by research grants from the National Taiwan University Hospital, Taipei, Taiwan (NTUH MS-419, NTUH 108-N4298) and the Ministry of Science and Technology, Taiwan (MOST 107-2221-E-002-080-MY3, 107-2314-B-002-247-MY3).

Author information

Authors and Affiliations

  1. Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Xu-Heng Chiang MD, Hsao-Hsun Hsu MD, PhD, Tung-Ming Tsai MD, Hsien-Chi Liao MD, Mong-Wei Lin MD, PhD & Jin-Shing Chen MD, PhD

  2. Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Min-Shu Hsieh MD, PhD

  3. Statistics Education Center, National Taiwan University, Taipei, Taiwan

    Chia-Hong Chang MS

  4. Department of Surgery, Taipei City Hospital, Taipei, Taiwan

    Kuan-Chuan Tsou MD

Authors
  1. Xu-Heng Chiang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hsao-Hsun Hsu MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Min-Shu Hsieh MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chia-Hong Chang MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tung-Ming Tsai MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hsien-Chi Liao MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kuan-Chuan Tsou MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mong-Wei Lin MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jin-Shing Chen MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mong-Wei Lin MD, PhD.

Ethics declarations

Disclosure

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chiang, XH., Hsu, HH., Hsieh, MS. et al. Propensity-Matched Analysis Comparing Survival After Sublobar Resection and Lobectomy for cT1N0 Lung Adenocarcinoma. Ann Surg Oncol 27, 703–715 (2020). https://doi.org/10.1245/s10434-019-07974-9

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-019-07974-9

Search

Navigation