Lobar offers no survival advantage over sublobar resections in NSCLC

Mar 31 2014

By Sarah Pritchard, medwireNews Reporter

Patients do not survive significantly longer after lobectomy for non-small-cell lung cancer (NSCLC) than after wedge resection or segmentectomy, indicate US study results.

A review published in Chest of more than 80 surgical tumour specimens from patients with NSCLC found that surgical method had no significant effect on survival, even after taking into account tumour size and the predominant tumour histology.

“[O]ur results begin to provide the surgeon with a rationale for choosing a less extensive surgical alternative for NSCLC, regardless of histologic subtype, without compromising patient outcomes”, write Francine Dembitzer (Icahn School of Medicine at Mount Sinai, New York) and co-workers.

They believe their findings corroborate the prognostic significance of the 2011 adenocarcinoma subtyping classification, which introduced the adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) subtypes, and suggested they should be treated with either wedge resection or segmentectomy.

A total of 59 lobectomy, 19 wedge resection and seven segmentectomy specimens from 85 patients were included in the study. Patient survival was followed up for a mean of 64 months after lobectomy and a mean of 38 months after wedge and segmentectomy procedures.

In all, 18 patients treated with lobectomy and three patients treated with either of the other methods died.

Dembitzer and colleagues observed that wedge resection and segmentectomy tumour specimens were on average smaller than lobectomy specimens, at 1.9 cm versus 2.7 cm, and that fewer lobectomy specimens were of the lowest pathological stage (pT1a), at 37% versus 65% for the other two procedures.

Similar numbers of patients had adenocarcinomas of the subtypes AIS, MIA and lepidic, at 3%, 3% and 7%, respectively, for those who underwent lobectomy, and a respective 4%, 3% and 4% for those who underwent wedge resection or segmentectomy.

However, in a multivariate analysis none of these factors affected the finding that patients’ length of survival did not differ significantly according to surgical method.

The researchers note that while they did not have access to complete information on disease-free as opposed to overall survival, all of the patients who died had tumours measuring more than 2 cm, and two of them had lymphatic and pleural invasion.

Furthermore, the team were unable to calculate the optimal distance of clearance for wedge resections using the data available, therefore an expansion of the current study is underway to include this.

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