Limited resection for the treatment of patients with stage IA lung cancer
Wisnivesky JP, Henschke CI, Swanson S, Yankelevitz DF, Zulueta J, Marcus S, Halm EA.
Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY, USA
Lobectomy is the standard of care for stage IA lung cancer. Some small retrospective studies have suggested similar results after limited resection for tumors < or =2 cm in size. The objective of the study was to compare survival after lobectomy and limited resection among Medicare patients with lung cancer.
Using the Surveillance, Epidemiology, and End Results registry, linked to Medicare records, we identified 1165 cases of stage I lung cancer < or =2 cm in size that underwent lobectomy or limited resection (segmentectomy or wedge resection). We used logistic regression to determine propensity scores for undergoing limited resection based on the patients' preoperative characteristics. Overall and lung cancer-specific survival of patients treated with lobectomy or limited resection was compared after adjusting for their propensity score.
Overall, 196 (17%) patients underwent limited resection. For the entire sample, the adjusted hazard ratio for all cause mortality (1.09; 95% confidence interval: 0.85-1.40) or lung cancer-specific death (hazard ratio: 1.39; 95% confidence interval: 0.97-2.01) for patients undergoing limited resection were not significantly different from those having lobectomy. Similarly, we found no significant differences in overall or lung cancer-specific survival for patients treated with limited resection compared with lobectomy when data was analyzed stratifying and matching patients by their propensity scores.
These results suggest that survival of patients >65 years of age undergoing limited resection or lobectomy for stage IA tumors < or =2 cm appears to be similar. Although these findings should be confirmed in prospective trials, our results suggest that limited resection may be an effective therapeutic alternative for these patients.
CITATION Ann Surg. 2010 Mar;251(3):550-4