- 作者：Nasser K. Altorki ; Rowena Yip ; Takaomi Hanaoka ; Thomas Bauer ; Ralph Aye ; Leslie Kohman ; Barry Sheppard ; Richard Thurer ; Shahriyour Andaz ; Michael Smith ; William Mayfield ; Fred Grannis ; Robert Korst ; Harvey Pass ; Michaela Straznicka ; Raja Flores ; Claudia I. Henschke ; I-ELCAP Investigators
- 关键词：10 ; 10.4 ; 36.1
- 刊名：The Journal of Thoracic and Cardiovascular Surgery
- 出版年：February, 2014
- 年：2014
- 卷：147
- 期：2
- 页码：754-764
- 全文大小：414 K
Objectives
A single randomized trial established lobectomy as the standard of care for the surgical treatment of early-stage non-small cell lung cancer. Recent advances in imaging/staging modalities and detection of smaller tumors have once again rekindled interest in sublobar resection for early-stage disease. The objective of this study was to compare lung cancer survival in patients with non-small cell lung cancer with a diameter of 30 mm or less with clinical stage 1 disease who underwent lobectomy or sublobar resection.Methods
We identified 347 patients diagnosed with lung cancer who underwent lobectomy (n聽=聽294) or sublobar resection (n聽=聽53) for non-small cell lung cancer manifesting as a solid nodule in the International Early Lung Cancer Action Program from 1993 to 2011. Differences in the distribution of the presurgical covariates between sublobar resection and lobectomy were assessed using unadjusted P values determined by logistic regression analysis. Propensity scoring was performed using the same covariates. Differences in the distribution of the same covariates between sublobar resection and lobectomy were assessed using adjusted P values determined by logistic regression analysis with adjustment for the propensity scores. Lung cancer-specific survival was determined by the Kaplan-Meier method. Cox survival regression analysis was used to compare sublobar resection with lobectomy, adjusted for the propensity scores, surgical, and pathology findings, when adjusted and stratified by propensity quintiles.
Results
Among 347 patients, 10-year Kaplan-Meier for 53 patients treated by sublobar resection compared with 294 patients treated by lobectomy was 85% (95% confidence interval, 80-91) versus 86% (confidence interval, 75-96) (P聽=聽.86). Cox survival analysis showed no significant difference between sublobar resection and lobectomy when adjusted for propensity scores or when using propensity quintiles (P聽=聽.62 and P聽=聽.79, respectively). For those with cancers 20 mm or less in diameter, the 10-year rates were 88% (95% confidence interval, 82-93) versus 84% (95% confidence interval, 73-96) (P聽=聽.45), and Cox survival analysis showed no significant difference between sublobar resection and lobectomy using either approach (P聽=聽.42 and P聽=聽.52, respectively).
Conclusions
Sublobar resection and lobectomy have equivalent survival for patients with clinical stage IA non-small cell lung cancer in the context of computed tomography screening for lung cancer.