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Lobectomy is superior to segmentectomy for peripheral high grade non-small cell lung cancer ≤2 cm

BACKGROUND: Current practice guidelines recommend the following criteria for segmentectomy for non-small cell lung cancer (NSCLC): size ≤2 cm, margins ≥2 cm and no lymph node involvement. We sought to further stratify the selection criteria for segmentectomy for small peripheral high-grade tumors. M...

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Autores principales: Baig, Mirza Zain, Razi, Syed S., Weber, Joanna F., Connery, Cliff P., Bhora, Faiz Y.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7656350/
https://www.ncbi.nlm.nih.gov/pubmed/33209425
http://dx.doi.org/10.21037/jtd-20-1530
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author Baig, Mirza Zain
Razi, Syed S.
Weber, Joanna F.
Connery, Cliff P.
Bhora, Faiz Y.
author_facet Baig, Mirza Zain
Razi, Syed S.
Weber, Joanna F.
Connery, Cliff P.
Bhora, Faiz Y.
author_sort Baig, Mirza Zain
collection PubMed
description BACKGROUND: Current practice guidelines recommend the following criteria for segmentectomy for non-small cell lung cancer (NSCLC): size ≤2 cm, margins ≥2 cm and no lymph node involvement. We sought to further stratify the selection criteria for segmentectomy for small peripheral high-grade tumors. METHODS: This retrospective database study was conducted using the Surveillance, Epidemiology and End Results (SEER) database. We queried for patients with high-grade (poorly differentiated/undifferentiated) pathological (p)T1a/b peripheral NSCLC (tumor size ≤2 cm), who underwent either lobectomy or segmentectomy between 2004 and 2015. Patients with node-positive disease or those who received any form of induction or adjuvant treatments were excluded. RESULTS: A total of 4,332 patients met the inclusion criteria, with 3,977 patients (91.8%) treated with lobectomy and 355 patients (8.2%) who underwent segmentectomy. In a propensity matched pair analysis of 640 patients, lobectomy (n=320) showed significantly improved 5-year survival of 45.9% vs. 33.8% for segmentectomy (n=320), P<0.01. In a multivariate Cox regression analysis, lobectomy was associated with significantly improved survival (HR: 0.84, 95% CI: 0.714–0.989, P=0.036). Interestingly, married status, adenocarcinoma histology, number of lymph nodes sampled were associated with better survival (P<0.05), while advanced age and male gender had worse survival outcomes (P<0.05). CONCLUSIONS: For small peripheral NSCLC ≤2 cm and high grades of tumor differentiation, lobectomy is associated with better long-term survival outcomes as compared to segmentectomy. Additional data is needed to further stratify various NSCLC histologies with their respective grades to allow for better selection for segmentectomy.
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spelling pubmed-76563502020-11-17 Lobectomy is superior to segmentectomy for peripheral high grade non-small cell lung cancer ≤2 cm Baig, Mirza Zain Razi, Syed S. Weber, Joanna F. Connery, Cliff P. Bhora, Faiz Y. J Thorac Dis Original Article BACKGROUND: Current practice guidelines recommend the following criteria for segmentectomy for non-small cell lung cancer (NSCLC): size ≤2 cm, margins ≥2 cm and no lymph node involvement. We sought to further stratify the selection criteria for segmentectomy for small peripheral high-grade tumors. METHODS: This retrospective database study was conducted using the Surveillance, Epidemiology and End Results (SEER) database. We queried for patients with high-grade (poorly differentiated/undifferentiated) pathological (p)T1a/b peripheral NSCLC (tumor size ≤2 cm), who underwent either lobectomy or segmentectomy between 2004 and 2015. Patients with node-positive disease or those who received any form of induction or adjuvant treatments were excluded. RESULTS: A total of 4,332 patients met the inclusion criteria, with 3,977 patients (91.8%) treated with lobectomy and 355 patients (8.2%) who underwent segmentectomy. In a propensity matched pair analysis of 640 patients, lobectomy (n=320) showed significantly improved 5-year survival of 45.9% vs. 33.8% for segmentectomy (n=320), P<0.01. In a multivariate Cox regression analysis, lobectomy was associated with significantly improved survival (HR: 0.84, 95% CI: 0.714–0.989, P=0.036). Interestingly, married status, adenocarcinoma histology, number of lymph nodes sampled were associated with better survival (P<0.05), while advanced age and male gender had worse survival outcomes (P<0.05). CONCLUSIONS: For small peripheral NSCLC ≤2 cm and high grades of tumor differentiation, lobectomy is associated with better long-term survival outcomes as compared to segmentectomy. Additional data is needed to further stratify various NSCLC histologies with their respective grades to allow for better selection for segmentectomy. AME Publishing Company 2020-10 /pmc/articles/PMC7656350/ /pubmed/33209425 http://dx.doi.org/10.21037/jtd-20-1530 Text en 2020 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Baig, Mirza Zain
Razi, Syed S.
Weber, Joanna F.
Connery, Cliff P.
Bhora, Faiz Y.
Lobectomy is superior to segmentectomy for peripheral high grade non-small cell lung cancer ≤2 cm
title Lobectomy is superior to segmentectomy for peripheral high grade non-small cell lung cancer ≤2 cm
title_full Lobectomy is superior to segmentectomy for peripheral high grade non-small cell lung cancer ≤2 cm
title_fullStr Lobectomy is superior to segmentectomy for peripheral high grade non-small cell lung cancer ≤2 cm
title_full_unstemmed Lobectomy is superior to segmentectomy for peripheral high grade non-small cell lung cancer ≤2 cm
title_short Lobectomy is superior to segmentectomy for peripheral high grade non-small cell lung cancer ≤2 cm
title_sort lobectomy is superior to segmentectomy for peripheral high grade non-small cell lung cancer ≤2 cm
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7656350/
https://www.ncbi.nlm.nih.gov/pubmed/33209425
http://dx.doi.org/10.21037/jtd-20-1530
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