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Landreneau RJ, Normolle DP, Christie NA, Awais O, Wizorek JJ, Abbas G, Pennathur A, Shende M, Weksler B, Luketich JD, Schuchert MJ. Recurrence and survival outcomes after anatomic segmentectomy versus lobectomy for clinical stage I non-small-cell lung cancer: a propensity-matched analysis. J Clin Oncol 2014; 32:2449-55. [PMID: 24982447 DOI: 10.1200/jco.2013.50.8762] [Citation(s) in RCA: 195] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Although anatomic segmentectomy has been considered a compromised procedure by many surgeons, recent retrospective, single-institution series have demonstrated tumor recurrence and patient survival rates that approximate those achieved by lobectomy. The primary objective of this study was to use propensity score matching to compare outcomes after these anatomic resection approaches for stage I non-small-cell lung cancer. PATIENTS AND METHODS A retrospective data set including 392 segmentectomy patients and 800 lobectomy patients was used to identify matched segmentectomy and lobectomy cohorts (n = 312 patients per group) using a propensity score matching algorithm that accounted for confounding effects of preoperative patient variables. Primary outcome variables included freedom from recurrence and overall survival. Factors affecting survival were assessed by Cox regression analysis and Kaplan-Meier estimates. RESULTS Perioperative mortality was 1.2% in the segmentectomy group and 2.5% in the lobectomy group (P = .38). At a mean follow-up of 5.4 years, comparing segmentectomy with lobectomy, no differences were noted in locoregional (5.5% v 5.1%, respectively; P = 1.00), distant (14.8% v 11.6%, respectively; P = .29), or overall recurrence rates (20.2% v 16.7%, respectively; P = .30). Furthermore, when comparing segmentectomy with lobectomy, no significant differences were noted in 5-year freedom from recurrence (70% v 71%, respectively; P = .467) or 5-year survival (54% v 60%, respectively; P = .258). Segmentectomy was not found to be an independent predictor of recurrence (hazard ratio, 1.11; 95% CI, 0.87 to 1.40) or overall survival (hazard ratio, 1.17; 95% CI, 0.89 to 1.52). CONCLUSION In this large propensity-matched comparison, lobectomy was associated with modestly increased freedom from recurrence and overall survival, but the differences were not statistically significant. These results will need further validation by prospective, randomized trials (eg, Cancer and Leukemia Group B 140503 trial).
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Affiliation(s)
- Rodney J Landreneau
- Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia.
| | - Daniel P Normolle
- Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia
| | - Neil A Christie
- Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia
| | - Omar Awais
- Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia
| | - Joseph J Wizorek
- Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia
| | - Ghulam Abbas
- Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia
| | - Arjun Pennathur
- Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia
| | - Manisha Shende
- Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia
| | - Benny Weksler
- Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia
| | - James D Luketich
- Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia
| | - Matthew J Schuchert
- Rodney J. Landreneau, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, and Matthew J. Schuchert, University of Pittsburgh Medical Center; Daniel P. Normolle, University of Pittsburgh, Pittsburgh, PA; and Rodney J. Landreneau, University of Queensland, Brisbane, Queensland, Australia
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Du G, Yang Y, Yang Y, Zhang Y, Sun T, Liu W, Wang Y, Li J, Zhang H. Thrombocytosis and immunohistochemical expression of connexin 43 at diagnosis predict survival in advanced non-small-cell lung cancer treated with cisplatin-based chemotherapy. Cancer Chemother Pharmacol 2013; 71:893-904. [PMID: 23355038 DOI: 10.1007/s00280-013-2080-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 01/08/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE Patients with advanced non-small-cell lung cancer (NSCLC) have poor survival, and platinum-based chemotherapy agents are the standard first-line chemotherapy agents for advanced NSCLC. This study aimed to identify predictive factors associated with the response to chemotherapy and survival in 258 patients with advanced NSCLC treated with platinum-based chemotherapy. METHODS Stage IIIA-IV NSCLC patients diagnosed in Kaifeng second people's hospital (Henan, China) between March 2002 and September 2011 were retrospectively reviewed. All of the patients had received platinum-based chemotherapy, and patients were followed up to date of death or last follow-up to obtain data of response to chemotherapy and survival. Potential prognostic factors such as gender, age, tumor size, tumor type, histologic stage, anemia, calcium levels, ECOG performance status (PS), thrombocytosis, TTF-1, p63, and connexin 43 were analyzed. Response to chemotherapy, overall survival (OS) and progression-free survival (PFS) were calculated by the Kaplan-Meier method and Cox regression model. RESULTS A univariate analysis indicated that thrombocytosis and connexin 43 were found to be significant prognostic factors (p < 0.001) and ECOG PS, Hb levels, and p63 presented a tendency toward association with survival. Kaplan-Meier survival showed that the mean OS and PFS in chemotherapy responders with connexin 43 ≥ +2 were significantly longer than in chemotherapy responders with connexin 43 ≤ 1+. In contrast, thrombocytosis was associated with increased mortality and resistance to chemotherapy in chemotherapy responders. In addition, all 21 patients of the 5-year OS were from chemotherapy responders with connexin 43 ≥ +2 or non-thrombocytosis. CONCLUSIONS Thrombocytosis and connexin 43 absence may be reliable surrogate markers for the prediction of chemotherapy response and prognosis for patients with advanced NSCLC, and assessment of these factors may identify a population of patients with advanced NSCLC that is likely to have a prolonged life expectancy.
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Affiliation(s)
- Gangjun Du
- Institute of Pharmacy, Pharmacy College of Henan University, Jinming street, Kaifeng, 475004 Henan, China.
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