Limited resection is inferior to lobectomy for older patients with early-stage invasive NSCLC, yielding lower overall survival and cancer-specific survival, according to a study published online Aug. 3 in Journal of Clinical Oncology.
Limited resection – wedge resection or segmentectomy – is increasingly chosen over lobectomy for patients older than 65 because it is thought to yield equivalent survival among patients who are already near the end of their lives and to cut down on perioperative and postoperative complications. Moreover, the number of these surgeries is expected to increase substantially when the recently released U.S. Preventive Services Task Force recommendations for lung cancer screening are fully implemented, said Dr. Rajwanth R. Veluswamy of the division of hematology and medical oncology, Mount Sinai University, New York, and his associates.
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However, the evidence supporting the equivalency of limited resection to lobectomy is scant and not of high quality. To examine the issue more closely, the investigators analyzed survival outcomes for 3,147 patients aged 65 and older who were included in the nationally representative population-based Surveillance, Epidemiology, and End Results (SEER) database. These patients had stage 1A NSCLC of 2 cm or less in diameter and were treated surgically in 1998 through 2009.
Limited resection was found to be inferior to lobectomy regarding overall survival (HR, 1.21) and lung cancer–specific survival (HR, 1.66) among patients with invasive adenocarcinoma. Limited resection also was inferior to lobectomy regarding overall survival (HR, 1.21) and lung cancer–specific survival (HR, 1.41) among patients with squamous cell carcinoma, Dr. Veluswamy and his associates said (J Clin Oncol. 2015 Aug. 3. doi:10.1200/JCO.2014.60.6624).
“Our findings should help decide the best treatment for older patients by balancing the potential short- and long-term risks of limited resection versus lobectomy,” they said.
The investigators added that they focused on patients older than age 65 because that is the age group most frequently affected by invasive NSCLC and most likely to be considered for limited resection. These results cannot be extrapolated to younger patients because they have longer life expectancies and thus higher risk of recurrence after “limited” treatment.
The U.S. Agency for Healthcare Research and Quality supported the study. Dr. Veluswamy had no disclosures; his associates reported ties to Pfizer, Otsuka, Teva Neuroscience, EHE International, United BioSource, Ethicon, Covidien, Genentech, IMS Health, Merck, Bristol-Myers Squibb, Quintiles, and Sanofi.