Christopher W Seder, Shu-Ching Chang, Christopher W Towe, Varun Puri, Justin D Blasberg, Levi Bonnell, Felix G Fernandez, Robert H Habib, Benjamin D Kozower
{"title":"对于IA期（≤2cm）非小细胞肺癌，解剖性肺切除术与楔形肺切除术相比可提高生存率。","authors":"Christopher W Seder, Shu-Ching Chang, Christopher W Towe, Varun Puri, Justin D Blasberg, Levi Bonnell, Felix G Fernandez, Robert H Habib, Benjamin D Kozower","doi":"10.1016/j.jtho.2025.03.042","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Given the uncertain generalizability of recent clinical trial data, a comparative effectiveness analysis examining the long-term survival of \"real world\" patients may clarify the role of lobectomy and sublobar resection (segmentectomy or wedge resection) in the treatment of early-stage non-small cell lung cancer (NSCLC).</p><p><strong>Methods: </strong>Adult patients undergoing lung resection for clinical stage IA NSCLC (≤2 cm) between 2012 and 2022 were identified from the Society of Thoracic Surgeons General Thoracic Surgery Database. Long-term vital status was determined by linkage to the National Death Index and Centers for Medicare & Medicaid Services inpatient data. The primary endpoint was overall survival (OS); secondary endpoints included lung cancer-specific survival (LCSS). Stabilized inverse probability weighted Cox Regression was used to account for selection bias and derive hazard ratios (HR) with 95% confidence intervals comparing the lobectomy, segmentectomy, and wedge resection cohorts.</p><p><strong>Results: </strong>Overall, 32,340 stage IA NSCLC patients (19,778 lobectomies [OS=71.9% (5-year), 44.8% (10-year)], 4,279 segmentectomies [OS=69.6%, 44.2%], and 8,283 wedge resections [OS=66.3%, 41.4%]) were examined. After risk adjustment, lobectomy was associated with improved OS and LCSS compared to sublobar resection [HR(OS)=0.87(0.83-0.92); HR(LCSS)=0.84(0.73-0.97)]. Both lobectomy [HR(OS)=0.84(0.80-0.88); HR(LCSS)=0.72(0.56-0.93)] and segmentectomy [HR(OS)=0.88(0.81-0.95); HR(LCSS)=0.77(0.66-0.89)] were associated with improved survival compared to wedge resection. No differences in OS or LCSS were observed between lobectomy and segmentectomy.</p><p><strong>Conclusion: </strong>In routine clinical practice, lobectomy and segmentectomy are associated with improved overall and lung cancer-specific survival compared with wedge resection for stage IA NSCLC (≤2 cm). These findings highlight the potential gap between trial efficacy and real-world effectiveness.</p>","PeriodicalId":17515,"journal":{"name":"Journal of Thoracic Oncology","volume":" ","pages":""},"PeriodicalIF":21.0000,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Anatomic Lung Resection is Associated with Improved Survival Compared with Wedge Resection for Stage IA (≤2 cm) Non-Small Cell Lung Cancer.\",\"authors\":\"Christopher W Seder, Shu-Ching Chang, Christopher W Towe, Varun Puri, Justin D Blasberg, Levi Bonnell, Felix G Fernandez, Robert H Habib, Benjamin D Kozower\",\"doi\":\"10.1016/j.jtho.2025.03.042\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Given the uncertain generalizability of recent clinical trial data, a comparative effectiveness analysis examining the long-term survival of \\\"real world\\\" patients may clarify the role of lobectomy and sublobar resection (segmentectomy or wedge resection) in the treatment of early-stage non-small cell lung cancer (NSCLC).</p><p><strong>Methods: </strong>Adult patients undergoing lung resection for clinical stage IA NSCLC (≤2 cm) between 2012 and 2022 were identified from the Society of Thoracic Surgeons General Thoracic Surgery Database. Long-term vital status was determined by linkage to the National Death Index and Centers for Medicare & Medicaid Services inpatient data. The primary endpoint was overall survival (OS); secondary endpoints included lung cancer-specific survival (LCSS). Stabilized inverse probability weighted Cox Regression was used to account for selection bias and derive hazard ratios (HR) with 95% confidence intervals comparing the lobectomy, segmentectomy, and wedge resection cohorts.</p><p><strong>Results: </strong>Overall, 32,340 stage IA NSCLC patients (19,778 lobectomies [OS=71.9% (5-year), 44.8% (10-year)], 4,279 segmentectomies [OS=69.6%, 44.2%], and 8,283 wedge resections [OS=66.3%, 41.4%]) were examined. After risk adjustment, lobectomy was associated with improved OS and LCSS compared to sublobar resection [HR(OS)=0.87(0.83-0.92); HR(LCSS)=0.84(0.73-0.97)]. Both lobectomy [HR(OS)=0.84(0.80-0.88); HR(LCSS)=0.72(0.56-0.93)] and segmentectomy [HR(OS)=0.88(0.81-0.95); HR(LCSS)=0.77(0.66-0.89)] were associated with improved survival compared to wedge resection. No differences in OS or LCSS were observed between lobectomy and segmentectomy.</p><p><strong>Conclusion: </strong>In routine clinical practice, lobectomy and segmentectomy are associated with improved overall and lung cancer-specific survival compared with wedge resection for stage IA NSCLC (≤2 cm). These findings highlight the potential gap between trial efficacy and real-world effectiveness.</p>\",\"PeriodicalId\":17515,\"journal\":{\"name\":\"Journal of Thoracic Oncology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":21.0000,\"publicationDate\":\"2025-03-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Thoracic Oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jtho.2025.03.042\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Thoracic Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jtho.2025.03.042","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
Anatomic Lung Resection is Associated with Improved Survival Compared with Wedge Resection for Stage IA (≤2 cm) Non-Small Cell Lung Cancer.
Introduction: Given the uncertain generalizability of recent clinical trial data, a comparative effectiveness analysis examining the long-term survival of "real world" patients may clarify the role of lobectomy and sublobar resection (segmentectomy or wedge resection) in the treatment of early-stage non-small cell lung cancer (NSCLC).
Methods: Adult patients undergoing lung resection for clinical stage IA NSCLC (≤2 cm) between 2012 and 2022 were identified from the Society of Thoracic Surgeons General Thoracic Surgery Database. Long-term vital status was determined by linkage to the National Death Index and Centers for Medicare & Medicaid Services inpatient data. The primary endpoint was overall survival (OS); secondary endpoints included lung cancer-specific survival (LCSS). Stabilized inverse probability weighted Cox Regression was used to account for selection bias and derive hazard ratios (HR) with 95% confidence intervals comparing the lobectomy, segmentectomy, and wedge resection cohorts.
Results: Overall, 32,340 stage IA NSCLC patients (19,778 lobectomies [OS=71.9% (5-year), 44.8% (10-year)], 4,279 segmentectomies [OS=69.6%, 44.2%], and 8,283 wedge resections [OS=66.3%, 41.4%]) were examined. After risk adjustment, lobectomy was associated with improved OS and LCSS compared to sublobar resection [HR(OS)=0.87(0.83-0.92); HR(LCSS)=0.84(0.73-0.97)]. Both lobectomy [HR(OS)=0.84(0.80-0.88); HR(LCSS)=0.72(0.56-0.93)] and segmentectomy [HR(OS)=0.88(0.81-0.95); HR(LCSS)=0.77(0.66-0.89)] were associated with improved survival compared to wedge resection. No differences in OS or LCSS were observed between lobectomy and segmentectomy.
Conclusion: In routine clinical practice, lobectomy and segmentectomy are associated with improved overall and lung cancer-specific survival compared with wedge resection for stage IA NSCLC (≤2 cm). These findings highlight the potential gap between trial efficacy and real-world effectiveness.
期刊介绍：
Journal of Thoracic Oncology (JTO), the official journal of the International Association for the Study of Lung Cancer,is the primary educational and informational publication for topics relevant to the prevention, detection, diagnosis, and treatment of all thoracic malignancies.The readship includes epidemiologists, medical oncologists, radiation oncologists, thoracic surgeons, pulmonologists, radiologists, pathologists, nuclear medicine physicians, and research scientists with a special interest in thoracic oncology.
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