Sublobar resection noninferior to lobectomy for patients with small-sized lung cancer
Click Here to Manage Email Alerts
Sublobar resection conferred similar survival outcomes as lobectomy among certain patients with non-small cell lung cancer, according to phase 3 study results.
The findings, presented during International Association for the Study of Lung Cancer World Conference on Lung Cancer, showed noninferior DFS and OS with the less extensive surgery specifically among patients with tumors of 2 cm or less in size.
Rationale and methods
“Lobectomy has been the surgical standard of care for early-stage NSCLC since 1995 and sublobar resection has been reserved for a subset of patients with marginal pulmonary reserve,” Nasser K. Altorki, MD, chief of thoracic surgery at Weill Cornell Medicine, said during his presentation. “Increased detection of small-sized peripheral NSCLC has renewed interest in sublobar resection in lieu of lobectomy.”
The multicenter international noninferiority phase 3 CALGB140503 (Alliance) trial included 697 patients (median age, 67.9 years; 90% white; 57.4% women) with clinical stage IA pathologically confirmed NSCLC and node-negative disease between June 2007 and March 2017.
Researchers randomly assigned patients to either lobectomy (n = 357) or sublobar resection (n = 340) according to tumor size, smoking status and tumor histology. The majority of sublobar resections (58.8%) consisted of wedge resections.
DFS served as the primary endpoint. Secondary outcomes included OS and postoperative difference in pulmonary function at 6 months.
Median follow-up was 7 years.
Key findings, implications
Results showed a 30-day mortality rate of 1.1% and 90-day mortality rate of 1.7% with lobectomy compared with 0.6% and 1.2% with sublobar resection.
At the time of data cutoff, the noninferiority significance boundary had not been crossed.
Altorki reported HRs of 1.01 (95% CI, 0.83-1.24) for DFS and 0.95 (95% CI, 0.75-1.21) for OS. The sublobar resection and lobectomy groups had similar rates of 5-year DFS (63.6% vs. 64.1%) and 5-year OS (80.3% vs. 78.9%).
Overall disease recurrence rates were 29.3% with lobectomy compared with 30.4% with sublobar resection.
“Disease recurrence was seen in approximately 30% of patients without significant difference between arms in the incidence of isolated locoregional or systemic recurrence,” Altorki said during his presentation.
Measures of pulmonary function showed a smaller absolute difference in magnitude of reduction among the sublobar resection group that may not be clinically meaningful, Altorki said.
“The results of this trial establish sublobar resection as the standard of care for this subset of patients,” Altorki said.
For more information:
Nasser K. Altorki, MD, can be reached at nkaltork@med.cornell.edu.
Collapse
Altorki NK, et al. Abstract PL03. Presented at: International Association for the Study of Lung Cancer World Conference on Lung Cancer (hybrid meeting); Aug. 6-9, 2022; Vienna.
Read more about
Click Here to Manage Email Alerts