Chest
Volume 139, Issue 3, March 2011, Pages 491-496
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Original Research
Lung Cancer
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

https://doi.org/10.1378/chest.09-2547Get rights and content

Background

Although lobectomy is the standard treatment for stage I non-small cell lung cancer (NSCLC), recent studies have suggested that limited resection may be a viable alternative for small-sized tumors. The objective of this study was to compare survival after lobectomy and limited resection among patients with stage IA tumors ≤ 1 cm by using a large, US-based cancer registry.

Methods

Using the Surveillance, Epidemiology, and End Results (SEER) registry, we identified 2,090 patients with stage I NSCLC ≤ 1 cm in size who underwent lobectomy or limited resection (segmentectomy or wedge resection). We used propensity score analysis to adjust for potential differences in the baseline characteristics of patients in the two treatment groups. Overall and lung cancer-specific survival rates of patients undergoing lobectomy vs limited resection were compared in stratified and adjusted analyses, controlling for propensity scores.

Results

Overall, 688 (33%) patients underwent limited resection. For the entire cohort, we were not able to identify a difference in outcomes among patients treated with lobectomy vs limited resection, as demonstrated by an adjusted hazard ratio (HR) for overall survival (1.12; 95% CI, 0.93-1.35) and lung cancer-specific survival (HR, 1.24; 95% CI, 0.95-1.61). Similarly, when the cohort was divided into propensity score quintiles, we did not find a difference in survival rate between the two groups.

Conclusions

Limited resection and lobectomy may lead to equivalent survival rates among patients with stage I NSCLC tumors ≤ 1 cm in size. If confirmed in prospective studies, limited resection may be preferable for the treatment of small tumors because it may be associated with fewer complications and better postoperative lung function.

Section snippets

Materials and Methods

Patients were selected from the Surveillance, Epidemiology, and End Results (SEER) program, which has collected clinicopathologic data on all incident cancer cases in specified geographic areas of the United States since 1972. The SEER program is a population-based cancer registry sponsored by the National Cancer Institute that routinely collects information on the incidence and survival rates of cancer in 18 areas of the United States. The SEER population is highly representative in terms of

Results

The analysis included 2,090 patients with stage I NSCLC ≤ 1 cm in size. Of these, 688 (33%) underwent limited resection. The median follow-up time for the entire cohort was 37 months; the minimal follow-up (for patients diagnosed in December 2004) was 1 year. Patients ≤ 60 years of age had a median follow-up time of 44 months, compared with 38 months for patients 60 to 70 years of age, and 31 months for patients > 70 years of age. Overall, 1,351 patients (64%) were alive at the end of the study

Discussion

Although it has been reported previously that patients with small-sized stage IA NSCLC can undergo resections of less than one lobe without leading to worse survival outcomes, controversy still remains regarding the treatment of choice for these tumors. In this study, we did not find a significant difference in survival among patients with stage IA NSCLC ≤ 1 cm in size treated with lobectomy vs limited resection. Our findings suggest that limited resection may be considered for the treatment of

Conclusions

In summary, our results suggest that there are similar survival rates among patients receiving limited resection vs lobectomy for ≤ 1 cm stage IA tumors, regardless of age. When our findings are viewed along with previously reported data demonstrating that limited resection is associated with fewer postoperative complications and better lung function, it would seem that limited resection may be preferable for tumors ≤ 1 cm in size, when technically possible. However, for a definitive

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