Survival better with lobectomy vs. wedge resection in early stage lung cancer
Key takeaways:
- Researchers observed a link between improved overall survival and lobectomy vs. sublobar resection.
- Researchers are working on a long-term risk calculator with these real-world data.
Among patients with stage IA non-small cell lung cancer, long-term survival was better with lobectomy or segmentectomy vs. wedge resection, according to results presented at the Society of Thoracic Surgeons Annual Meeting.
“We believe that these results are quite powerful and informative,” Christopher Seder, MD, thoracic surgeon at Rush University Medical Center, told Healio.
Using the Society of Thoracic Surgeons General Thoracic Surgery Database, Seder and colleagues assessed 32,340 adults with stage IA non-small cell lung cancer less than or equal to 2 cm who experienced lung resection surgery to determine how 10-year overall survival and 7-year lung cancer-specific survival differ based on receipt of lobectomy vs. sublobar resection (wedge or segmentectomy).
“We linked, for the first time ever, the Society for Thoracic Surgeons database to not only the CMS database, but also the [CDC] National Death Index,” Seder told Healio.
Most of the study population underwent lobectomy (n = 19,778), followed by wedge resection (n = 8,283) and segmentectomy (n = 4,279), according to the abstract.
“Twenty percent of patients who had wedge resections did not have any nodes taken whatsoever,” Seder told Healio. “Patients who got wedge resections also had less nodal sampling, less nodal stations sampled, less nodal upstaging and more positive margins.”
Researchers found the largest proportion of survivors after 5 years in the lobectomy group at 71.9%. The segmentectomy group had the second highest 5-year overall survival rate at 69.6%, followed by the wedge resection group at 66.3%.
When evaluating 10-year overall survival, the lobectomy group and segmentectomy group had comparable proportions of patients (44.8% and 44.2%), with the wedge resection group following behind at 41.4%.
Researchers observed a link between improved overall survival and lobectomy vs. sublobar resection (HR = 0.87; 95% CI, 0.83-0.92), as well as between improved lung cancer-specific survival and lobectomy vs. sublobar (HR = 0.91; 95% CI, 0.86-0.96).
Notably, this link was still found after factoring out pathologic-upstaged cases in a sensitivity analysis, according to the abstract.
After breaking down sublobar resection into wedge resection and segmentectomy, the above relationship between lobectomy and better overall and lung cancer-specific survival continued only when placed against wedge resection (overall survival HR = 0.84; 95% CI, 0.8-0.88; lung cancer-specific survival HR = 0.88; 95% CI, 0.83-0.93).
Of the two sublobar resection procedures, researchers reported better overall survival with segmentectomy (HR = 0.88; 95% CI, 0.81-0.95), and the same was true for lung cancer-specific survival (HR = 0.91; 95% CI, 0.83-1). In contrast, survival was comparable between these two procedures in sensitivity analysis, according to the abstract.
“We found that what happens on the trial basis cannot necessarily be applied to the real world unless you follow the exact trial protocols ... but in the real world, our data are showing us that surgeons are not doing that,” Seder told Healio.
“Surgeons are likely using sublobar or wedge resections as a compromise operation, meaning in a patient who may not tolerate a lobectomy, they may do a wedge resection on that patient, and you can’t expect as good a result if you’re selecting your patients that way,” Seder continued.
When asked how these real-world data will be used moving forward, Seder said his team is working on a long-term risk calculator.
“The Society of Thoracic Surgeons has had short-term risk models for quite a long time,” Seder told Healio. “You can predict what a patient’s expected post-operative morbidity and 30-day mortality is.
“In the next couple months, we’re going to incorporate long-term outcomes,” Seder continued. “You will be able to put a patient in there with a given tumor and then toggle between wedge resection, segmentectomy and lobectomy and see how not only your short-term outcomes would change depending on what operation you do, but how your long-term outcomes are expected to change.”
Seder also noted that these results do not necessarily mean that these patients should be sent to radiation rather than surgery because there are three benefits to surgery in terms of patient care.
“Surgery gives you adequate nodal staging,” Seder told Healio. “It also gives us a piece of tumor to work with that can be sequenced with next generation sequencing, and finally, we know that surgery is extraordinarily safe.”
References:
- Anatomic lung resection linked to improved survival for early-stage lung cancer. https://www.sts.org/press-releases/anatomic-lung-resection-linked-improved-survival-early-stage-lung-cancer. Published Jan. 25, 2025. Accessed Jan. 25, 2025.
- STS risk calculators. https://www.sts.org/resources/calculators-tools/sts-risk-calculators#general-thoracic-risk-calculators. Accessed Jan. 28, 2025.