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Tytuł:
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Equivalent Survival Between Lobectomy and Segmentectomy for Clinical Stage IA Lung Cancer.
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Autorzy:
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Onaitis MW; Division of Cardiothoracic Surgery, University of California San Diego, La Jolla, California. Electronic address: .
Furnary AP; Starr-Wood Cardiac Group, Portland, Oregon.
Kosinski AS; Duke Clinical Research Institute, Duke University, Durham, North Carolina.
Feng L; Duke Clinical Research Institute, Duke University, Durham, North Carolina.
Boffa D; Division of Cardiothoracic Surgery, Yale University, New Haven, Connecticut.
Tong BC; Division of Cardiothoracic Surgery, Duke University, Durham, North Carolina.
Cowper P; Duke Clinical Research Institute, Duke University, Durham, North Carolina.
Jacobs JP; Johns Hopkins All Children's Heart Institute, St Petersburg, Florida.
Wright CD; Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Habib R; The Society of Thoracic Surgeons, Chicago, Illinois.
Putnam JB Jr; Baptist MD Anderson Cancer Center, Jacksonville, Florida.
Fernandez FG; Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia.
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Źródło:
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The Annals of thoracic surgery [Ann Thorac Surg] 2020 Dec; Vol. 110 (6), pp. 1882-1891. Date of Electronic Publication: 2020 Feb 29.
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Typ publikacji:
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Journal Article; Research Support, U.S. Gov't, P.H.S.
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Język:
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English
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Imprint Name(s):
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Publication: Amsterdam : Elsevier
Original Publication: Boston.
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MeSH Terms:
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Lung Neoplasms/*mortality
Lung Neoplasms/*surgery
Aged ; Aged, 80 and over ; Databases, Factual ; Female ; Humans ; Lung Neoplasms/pathology ; Male ; Medicare ; Neoplasm Staging ; Propensity Score ; Proportional Hazards Models ; Survival Rate ; United States
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Grant Information:
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R01 HS022279 United States HS AHRQ HHS
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Entry Date(s):
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Date Created: 20200303 Date Completed: 20201229 Latest Revision: 20210708
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Update Code:
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20240105
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DOI:
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10.1016/j.athoracsur.2020.01.020
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PMID:
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32119855
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Background: The oncologic efficacy of segmentectomy is controversial. We compared long-term survival in clinical stage IA (T1N0) Medicare patients undergoing lobectomy and segmentectomy in The Society of Thoracic Surgeons database.
Methods: The Society of Thoracic Surgeons General Thoracic Surgery Database was linked to Medicare data in 14,286 lung cancer patients who underwent segmentectomy (n = 1654) or lobectomy (n = 12,632) for clinical stage IA disease from 2002 to 2015. Cox regression was used to create a long-term survival model. Patients were then propensity matched on demographic and clinical variables to derive matched pairs.
Results: In Cox modeling segmentectomy was associated with survival similar to lobectomy in the entire cohort (hazard ratio, 1.04; 95% confidence interval, 0.89-1.20; P = .64) and in the matched subcohort. A subanalysis restricted to the 2009 to 2015 population (n = 11,811), when T1a tumors were specified and positron emission tomography results and mediastinal staging procedures were accurately recorded in the database, also showed that segmentectomy and lobectomy continue to have similar survival (hazard ratio, 1.00; 95% confidence interval, 0.87-1.16). Subanalysis of the pathologic N0 patients demonstrated the same results.
Conclusions: Lobectomy and segmentectomy for early-stage lung cancer are equally effective treatments with similar survival. Surgeons from The Society of Thoracic Surgeons database appear to be selecting patients appropriately for sublobar procedures.
(Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
