Conditional survival rate estimates of lobectomy, segmentectomy and wedge resection for stage IA1 non‑small cell lung cancer: A population‑based study

Fan,Xiaoxi; Liang,Yicheng; Bai,Yunpeng; Yang,Chunlu; Xu,Shun

doi:10.3892/ol.2020.11713

Conditional survival rate estimates of lobectomy, segmentectomy and wedge resection for stage IA1 non‑small cell lung cancer: A population‑based study

Authors:
- Xiaoxi Fan
- Yicheng Liang
- Yunpeng Bai
- Chunlu Yang
- Shun Xu
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Affiliations: Department of Thoracic Surgery, First Hospital of China Medical University, Shenyang, Liaoning 110001, P.R. China
Published online on: June 9, 2020 https://doi.org/10.3892/ol.2020.11713
Pages: 1607-1618
Copyright: © Fan et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Conditional survival rate (CSR) is defined as the dynamic possibility of survival, considering the changes in the survival risk over time. The present study aimed to compare the CSR of the surgical procedures for stage IA1 non‑small cell lung cancer (NSCLC). Overall, data for 2,535 patients with stage IA1 NSCLC after lobectomy, segmentectomy or wedge resection were obtained from the Surveillance, Epidemiology and End Results database, and the overall survival (OS) rates were subsequently compared. CSR estimates, the possibility of patients who had already survived x years, to survive further y years, was calculated as CSR=S(x+y)/S(x), where S is the survival rate at a particular point in time. A Cox regression model and propensity‑score matching were used to adjust confounding factors. There were no statistical differences in the OS among the three surgical procedures, except that OS of patients who underwent a lobectomy was improved compared with the wedge resection. The CSR of surviving to the 5th year after operation improved gradually over time. The 3‑year CSR of lobectomy or segmentectomy was higher compared with that of the wedge resection. Moreover, the 3‑year CSR of segmentectomy was higher compared with that of lobectomy from the 3rd year after surgery, particularly in some specific situations, such as female sex, patients ≥66 years old, patients with squamous cell carcinoma or patients with poor tumor differentiation. The present study is the first report to compare CSR following lobectomy, segmentectomy and wedge resection for patients with stage IA1 NSCLC, to the best of our knowledge. These findings indicated that lobectomy is the most conservative surgical procedure for stage IA1 NSCLC and raises questions regarding improved long‑term prognosis of segmentectomy in some subsets of patients.

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1	National Lung Screening Trial Research Team, . Church TR, Black WC, Aberle DR, Berg CD, Clingan KL, Duan F, Fagerstrom RM, Gareen IF, Gierada DS, et al: Results of initial low-dose computed tomographic screening for lung cancer. N Engl J Med. 368:1980–1991. 2013. View Article : Google Scholar : PubMed/NCBI
2	Ginsberg RJ and Rubinstein LV: Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg. 60:615–622. 1995. View Article : Google Scholar : PubMed/NCBI
3	Dai C, Shen J, Ren Y, Zhong S, Zheng H, He J, Xie D, Fei K, Liang W, Jiang G, et al: Choice of surgical procedure for patients with non-small-cell lung Cancer </=1 cm or >1 to 2 cm among lobectomy, segmentectomy, and wedge resection: A population-based study. J Clin Oncol. 34:3175–3182. 2016. View Article : Google Scholar : PubMed/NCBI
4	Widder J, Van De Wauwer C and Langendijk JA: Lobectomy or sublobectomy for small non-small-cell lung cancer: The question remains. J Clin Oncol. 35:572–573. 2017. View Article : Google Scholar : PubMed/NCBI
5	Cao C, Chandrakumar D, Gupta S, Yan TD and Tian DH: Could less be more? A systematic review and meta-analysis of sublobar resections versus lobectomy for non-small cell lung cancer according to patient selection. Lung Cancer. 89:121–132. 2015. View Article : Google Scholar : PubMed/NCBI
6	Altorki NK, Yip R, Hanaoka T, Bauer T, Aye R, Kohman L, Sheppard B, Thurer R, Andaz S, Smith M, et al: Sublobar resection is equivalent to lobectomy for clinical stage 1A lung cancer in solid nodules. J Thorac Cardiovasc Surg. 147:754–762. 2014. View Article : Google Scholar : PubMed/NCBI
7	Fiorelli A, Caronia FP, Daddi N, Loizzi D, Ampollini L, Ardo N, Ventura L, Carbognani P, Potenza R, Ardissone F, et al: Sublobar resection versus lobectomy for stage I non-small cell lung cancer: An appropriate choice in elderly patients? Surg Today. 46:1370–1382. 2016. View Article : Google Scholar : PubMed/NCBI
8	Kodama K, Doi O, Higashiyama M and Yokouchi H: Intentional limited resection for selected patients with T1 N0 M0 non-small-cell lung cancer: A single-institution study. J Thorac Cardiovasc Surg. 114:347–353. 1997. View Article : Google Scholar : PubMed/NCBI
9	Koike T, Yamato Y, Yoshiya K, Shimoyama T and Suzuki R: Intentional limited pulmonary resection for peripheral T1 N0 M0 small-sized lung cancer. J Thorac Cardiovasc Surg. 125:924–928. 2003. View Article : Google Scholar : PubMed/NCBI
10	Bao F, Ye P, Yang Y, Wang L, Zhang C, Lv X and Hu J: Segmentectomy or lobectomy for early stage lung cancer: A meta-analysis. Eur J Cardiothorac Surg. 46:1–7. 2014. View Article : Google Scholar : PubMed/NCBI
11	Donahue JM, Morse CR, Wigle DA, Allen MS, Nichols FC, Shen KR, Deschamps C and Cassivi SD: Oncologic efficacy of anatomic segmentectomy in stage IA lung cancer patients with T1a tumors. Ann Thorac Surg. 93:381–387. 2012. View Article : Google Scholar : PubMed/NCBI
12	Kates M, Swanson S and Wisnivesky JP: Survival following lobectomy and limited resection for the treatment of stage I non-small cell lung cancer <=1 cm in size: A review of SEER data. Chest. 139:491–496. 2011. View Article : Google Scholar : PubMed/NCBI
13	Harada H, Okada M, Sakamoto T, Matsuoka H and Tsubota N: Functional advantage after radical segmentectomy versus lobectomy for lung cancer. Ann Thorac Surg. 80:2041–2045. 2005. View Article : Google Scholar : PubMed/NCBI
14	Detterbeck FC, Boffa DJ, Kim AW and Tanoue LT: The eighth edition lung cancer stage classification. Chest. 151:193–203. 2017. View Article : Google Scholar : PubMed/NCBI
15	Cao J, Yuan P, Wang Y, Xu J, Yuan X, Wang Z, Lv W and Hu J: Survival rates after lobectomy, segmentectomy, and wedge resection for non-small cell lung cancer. Ann Thorac Surg. 105:1483–1491. 2018. View Article : Google Scholar : PubMed/NCBI
16	Callister ME, Baldwin DR, Akram AR, Barnard S, Cane P, Draffan J, Franks K, Gleeson F, Graham R, Malhotra P, et al: British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax. 70 (Suppl 2):ii1–ii54. 2015. View Article : Google Scholar : PubMed/NCBI
17	Merrill RM, Henson DE and Barnes M: Conditional survival among patients with carcinoma of the lung. Chest. 116:697–703. 1999. View Article : Google Scholar : PubMed/NCBI
18	Henson DE and Ries LA: On the estimation of survival. Semin Surg Oncol. 10:2–6. 1994. View Article : Google Scholar : PubMed/NCBI
19	Wang SJ, Fuller CD and Thomas CR Jr: Ethnic disparities in conditional survival of patients with non-small cell lung cancer. J Thorac Oncol. 2:180–190. 2007. View Article : Google Scholar : PubMed/NCBI
20	National Cancer Institute: Surveillance, Epidemiology, and End Results. PubMed/NCBI
21	Stuart EA, Lee BK and Leacy FP: Prognostic score-based balance measures can be a useful diagnostic for propensity score methods in comparative effectiveness research. J Clin Epidemiol. 66 (Suppl 8):S84–S90.e1. 2013. View Article : Google Scholar : PubMed/NCBI
22	Austin PC: Statistical criteria for selecting the optimal number of untreated subjects matched to each treated subject when using many-to-one matching on the propensity score. Am J Epidemiol. 172:1092–1097. 2010. View Article : Google Scholar : PubMed/NCBI
23	R Core Team, . 2012.R: A language and environment for statistical computing. R Foundation for Statistical Computing. (Vienna, Austria). ISBN 3-900051-07-0, URL http://www.R-project.org.
24	Miller DL, Rowland CM, Deschamps C, Allen MS, Trastek VF and Pairolero PC: Surgical treatment of non-small cell lung cancer 1 cm or less in diameter. Ann Thorac Surg. 73:1545–1550. 2002. View Article : Google Scholar : PubMed/NCBI
25	Zhang Y, Sun Y, Wang R, Ye T, Zhang Y and Chen H: Meta-analysis of lobectomy, segmentectomy, and wedge resection for stage I non-small cell lung cancer. J Surg Oncol. 111:334–340. 2015. View Article : Google Scholar : PubMed/NCBI
26	Cao C, Gupta S, Chandrakumar D, Tian DH, Black D and Yan TD: Meta-analysis of intentional sublobar resections versus lobectomy for early stage non-small cell lung cancer. Ann Cardiothorac Surg. 3:134–141. 2014.PubMed/NCBI
27	Groth SS, Rueth NM, Hodges JS, Habermann EB, Andrade RS, D'Cunha J and Maddaus MA: Conditional cancer-specific versus cardiovascular-specific survival after lobectomy for stage I non-small cell lung cancer. Ann Thorac Surg. 90:375–382. 2010. View Article : Google Scholar : PubMed/NCBI
28	Rodin G, Lo C, Rydall A, Shnall J, Malfitano C, Chiu A, Panday T, Watt S, An E, Nissim R, et al: Managing cancer and living meaningfully (CALM): A randomized controlled trial of a psychological intervention for patients with advanced cancer. J Clin Oncol. 36:2422–2432. 2018. View Article : Google Scholar : PubMed/NCBI
29	Khullar OV, Liu Y, Gillespie T, Higgins KA, Ramalingam S, Lipscomb J and Fernandez FG: Survival after sublobar resection versus lobectomy for clinical stage IA Lung Cancer: An analysis from the national cancer data base. J Thorac Oncol. 10:1625–1633. 2015. View Article : Google Scholar : PubMed/NCBI
30	Sihoe AD and Van Schil P: Non-small cell lung cancer: When to offer sublobar resection. Lung Cancer. 86:115–120. 2014. View Article : Google Scholar : PubMed/NCBI
31	Liang W, He J, Shen Y, Shen J, He Q, Zhang J, Jiang G, Wang Q, Liu L, Gao S, et al: Impact of examined lymph node count on precise staging and long-term survival of resected non-small-cell lung cancer: A population study of the US SEER database and a Chinese Multi-Institutional Registry. J Clin Oncol. 35:1162–1170. 2017. View Article : Google Scholar : PubMed/NCBI
32	Tong BC, Kosinski AS, Burfeind WR Jr, Onaitis MW, Berry MF, Harpole DH Jr and D'Amico TA: Sex differences in early outcomes after lung cancer resection: Analysis of the Society of Thoracic Surgeons General Thoracic Database. J Thorac Cardiovasc Surg. 148:13–18. 2014. View Article : Google Scholar : PubMed/NCBI
33	Paleari L, Russo P, Cesario A and Granone P: Factors predicting poor survival after resection of stage IA non-small cell lung cancer. J Thorac Cardiovasc Surg. 136:241–242. 2008. View Article : Google Scholar : PubMed/NCBI
34	Kozower BD, Sheng S, O'Brien SM, Liptay MJ, Lau CL, Jones DR, Shahian DM and Wright CD: STS database risk models: Predictors of mortality and major morbidity for lung cancer resection. Ann Thorac Surg. 90:875–881. 2010. View Article : Google Scholar : PubMed/NCBI
35	Bosco JL, Silliman RA, Thwin SS, Geiger AM, Buist DS, Prout MN, Yood MU, Haque R, Wei F and Lash TL: A most stubborn bias: No adjustment method fully resolves confounding by indication in observational studies. J Clin Epidemiol. 63:64–74. 2010. View Article : Google Scholar : PubMed/NCBI
36	NCCN Clinical Practice Guidelines in Oncology, . Non-small cell lung cancer (v.2.2013). Available at: http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf. May 1–2016