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Yim S, Lin WC, Liu JS, Yen MH. Survival after thermal ablation versus wedge resection for stage I non-small cell lung cancer < 1 cm and 1 to 2 cm: evidence from the US SEER database. Cancer Imaging 2024; 24:91. [PMID: 38992679 PMCID: PMC11238439 DOI: 10.1186/s40644-024-00733-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/25/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND This study compared the survival outcomes after thermal ablation versus wedge resection in patients with stage I non-small cell lung cancer (NSCLC) ≤ 2 cm. METHODS Data from the United States (US) National Cancer Institute Surveillance Epidemiology and End Results (SEER) database from 2004 to 2019 were retrospectively analyzed. Patients with stage I NSCLC and lesions ≤ 2 cm who received thermal ablation or wedge resection were included. Patients who received chemotherapy or radiotherapy were excluded. Propensity-score matching (PSM) was applied to balance the baseline characteristics between patients who underwent the two procedures. RESULTS Univariate and Cox regression analyses were performed to determine the associations between study variables, overall survival (OS), and cancer-specific survival (CSS). After PSM, 328 patients remained for analysis. Multivariable Cox regression analysis revealed, compared to wedge resection, thermal ablation was significantly associated with a greater risk of poor OS (adjusted HR [aHR]: 1.34, 95% CI: 1.09-1.63, p = 0.004) but not CSS (aHR: 1.28, 95% CI: 0.96-1.71, p = 0.094). In stratified analyses, no significant differences were observed with respect to OS and CSS between the two procedures regardless of histology and grade. In patients with tumor size 1 to 2 cm, compared to wedge resection, thermal ablation was significantly associated with a higher risk of poor OS (aHR: 1.35, 95% CI: 1.10-1.66, p = 0.004). In contrast, no significant difference was found on OS and CSS between thermal ablation and wedge resection among those with tumor size < 1 cm. CONCLUSIONS In patients with stage I NSCLC and tumor size < 1 cm, thermal ablation has similar OS and CSS with wedge resection.
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Affiliation(s)
- Shelly Yim
- Division of Chest Surgery, Department of Surgery, Cathay General Hospital, No. 280, Sec. 4, Renai Road, Daan District, Taipei, 106, Taiwan
- School of Medicine, Fu-Jen Catholic University, No. 69, Guizi Road, Taishan District, New Taipei City, 22241, Taiwan
| | - Wei Chan Lin
- Department of Radiology, Cathay General Hospital, No. 280, Sec. 4, Renai Road, Daan District, Taipei, 106, Taiwan
- School of Medicine, Fu-Jen Catholic University, No. 69, Guizi Road, Taishan District, New Taipei City, 22241, Taiwan
| | - Jung Sen Liu
- Division of Chest Surgery, Department of Surgery, Cathay General Hospital, No. 280, Sec. 4, Renai Road, Daan District, Taipei, 106, Taiwan
- School of Medicine, Fu-Jen Catholic University, No. 69, Guizi Road, Taishan District, New Taipei City, 22241, Taiwan
| | - Ming Hong Yen
- Division of Chest Surgery, Department of Surgery, Cathay General Hospital, No. 280, Sec. 4, Renai Road, Daan District, Taipei, 106, Taiwan.
- School of Medicine, Fu-Jen Catholic University, No. 69, Guizi Road, Taishan District, New Taipei City, 22241, Taiwan.
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Zhang W, Chen S, Lin X, Chen H, He R. Lobectomy versus segmentectomy for stage IA3 (T1cN0M0) non-small cell lung cancer: a meta-analysis and systematic review. Front Oncol 2023; 13:1270030. [PMID: 37849809 PMCID: PMC10578965 DOI: 10.3389/fonc.2023.1270030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/06/2023] [Indexed: 10/19/2023] Open
Abstract
Background Segmentectomy has been proven to have better survival and perioperative efficacy than lobectomy for non-small cell lung cancer (NSCLC) up to 2 cm. Whether this result is applicable to stage T1cN0M0 NSCLC (2.1 to 3 cm) remains controversial. Methods We conducted a comprehensive search across seven databases to identify relevant studies comparing lobectomy and segmentectomy procedures. Our primary focus was on survival indicators (overall survival [OS] and disease-free survival [DFS]), while for secondary outcomes, operative outcomes, hospitalization outcomes, recurrences, and complications were considered. Results After screening, the final analysis included 10 studies (involving 22113 patients in the lobectomy group and 1627 patients in the segmentectomy group). The lobectomy procedure achieved better OS (hazard ratio [HR]: 1.19 [1.07~1.33]) and DFS (HR: 1.37 [1.10~1.71]), which were proven in all subgroups. The OS rate at 2-5 years and DFS rate at 4-5 years were higher in the lobectomy group. The advantages of OS and DFS in the lobectomy group increased over the survival time. More lymph node dissections, intraoperative blood loss and total complications were found in the lobectomy group. Similar hospital stays, 90-day mortality and conversion thoracotomy were found between the two groups. Conclusion Lobectomy appeared to be the better choice for patients with stage T1cN0M0 NSCLC with better survival (OS and DFS). However, the complications needed to be taken seriously. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identification CRD42023445013.
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Affiliation(s)
| | | | | | | | - Rongqi He
- Department of Thoracic Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China
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Smoking Habit and Respiratory Function Predict Patients' Outcome after Surgery for Lung Cancer, Irrespective of Histotype and Disease Stage. J Clin Med 2023; 12:jcm12041561. [PMID: 36836096 PMCID: PMC9967492 DOI: 10.3390/jcm12041561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/05/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Growing evidence suggests that sublobar resections offer more favorable outcomes than lobectomy in early-stage lung cancer surgery. However, a percentage of cases that cannot be ignored develops disease recurrence irrespective of the surgery performed with curative intent. The goal of this work is thus to compare different surgical approaches, namely, lobectomy and segmentectomy (typical and atypical) to derive prognostic and predictive markers. PATIENTS AND METHODS Here we analyzed a cohort of 153 NSCLC patients in clinical stage TNM I who underwent pulmonary resection surgery with a mediastinal hilar lymphadenectomy from January 2017 to December 2021, with an average follow-up of 25.5 months. Partition analysis was also applied to the dataset to detect outcome predictors. RESULTS The results of this work showed similar OS between lobectomy and typical and atypical segmentectomy for patients with stage I NSCLC. In contrast, lobectomy was associated with a significant improvement in DFS compared with typical segmentectomy in stage IA, while in stage IB and overall, the two treatments were similar. Atypical segmentectomy showed the worst performance, especially in 3-year DFS. Quite unexpectedly, outcome predictor ranking analysis suggests a prominent role of smoking habits and respiratory function, irrespective of the tumor histotype and the patient's gender. CONCLUSIONS Although the limited follow-up interval cannot allow conclusive remarks about prognosis, the results of this study suggest that both lung volumes and the degree of emphysema-related parenchymal damage are the strongest predictors of poor survival in lung cancer patients. Overall, these data point out that greater attention should be addressed to the therapeutic intervention for co-existing respiratory diseases to obtain optimal control of early lung cancer.
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Gelzinis TA. Pulmonary Segmentectomy: A New Standard of Care in Patients with Non-Small Cell Cancer. J Cardiothorac Vasc Anesth 2022; 36:3987-3989. [PMID: 35933274 DOI: 10.1053/j.jvca.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 07/02/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Theresa A Gelzinis
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA.
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