Recurrence and survival outcomes after anatomic segmentectomy versus lobectomy for clinical stage I non- Small-cell lung cancer

A propensity-matched analysis

Rodney J. Landreneau, Daniel P. Normolle, Neil A. Christie, Omar Awais, Joseph J. Wizorek, Ghulam Abbas, Arjun Pennathur, Manisha Shende, Benny Weksler, James D. Luketich, Matthew J. Schuchert

Research output: Contribution to journalArticle

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Abstract

Purpose: Although anatomic segmentectomy has been considered a compromised procedure by many surgeons, recent retrospective, single-institution series have demonstrated tumor recurrence and patient survival rates that approximate those achieved by lobectomy. The primary objective of this study was to use propensity score matching to compare outcomes after these anatomic resection approaches for stage I non-small-cell lung cancer. Patients and Methods: A retrospective data set including 392 segmentectomy patients and 800 lobectomy patients was used to identify matched segmentectomy and lobectomy cohorts (n = 312 patients per group) using a propensity score matching algorithm that accounted for confounding effects of preoperative patient variables. Primary outcome variables included freedom from recurrence and overall survival. Factors affecting survival were assessed by Cox regression analysis and Kaplan-Meier estimates. Results: Perioperative mortality was 1.2% in the segmentectomy group and 2.5% in the lobectomy group (P = .38). At a mean follow-up of 5.4 years, comparing segmentectomy with lobectomy, no differences were noted in locoregional (5.5% v 5.1%, respectively; P = 1.00), distant (14.8% v 11.6%, respectively; P = .29), or overall recurrence rates (20.2% v 16.7%, respectively; P = .30). Furthermore, when comparing segmentectomy with lobectomy, no significant differences were noted in 5-year freedom from recurrence (70% v 71%, respectively; P = .467) or 5-year survival (54% v 60%, respectively; P = .258). Segmentectomy was not found to be an independent predictor of recurrence (hazard ratio, 1.11; 95% CI, 0.87 to 1.40) or overall survival (hazard ratio, 1.17; 95% CI, 0.89 to 1.52). Conclusion: In this large propensity-matched comparison, lobectomy was associated with modestly increased freedom from recurrence and overall survival, but the differences were not statistically significant. These results will need further validation by prospective, randomized trials (eg, Cancer and Leukemia Group B 140503 trial).

Original languageEnglish (US)
Pages (from-to)2449-2455
Number of pages7
JournalJournal of Clinical Oncology
Volume32
Issue number23
DOIs
StatePublished - Aug 10 2014

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Segmental Mastectomy
Non-Small Cell Lung Carcinoma
Recurrence
Survival
Propensity Score
Kaplan-Meier Estimate
Neoplasms
Leukemia
Survival Rate
Regression Analysis
Mortality

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Recurrence and survival outcomes after anatomic segmentectomy versus lobectomy for clinical stage I non- Small-cell lung cancer : A propensity-matched analysis. / Landreneau, Rodney J.; Normolle, Daniel P.; Christie, Neil A.; Awais, Omar; Wizorek, Joseph J.; Abbas, Ghulam; Pennathur, Arjun; Shende, Manisha; Weksler, Benny; Luketich, James D.; Schuchert, Matthew J.

In: Journal of Clinical Oncology, Vol. 32, No. 23, 10.08.2014, p. 2449-2455.

Research output: Contribution to journalArticle

Landreneau, RJ, Normolle, DP, Christie, NA, Awais, O, Wizorek, JJ, Abbas, G, Pennathur, A, Shende, M, Weksler, B, Luketich, JD & Schuchert, MJ 2014, 'Recurrence and survival outcomes after anatomic segmentectomy versus lobectomy for clinical stage I non- Small-cell lung cancer: A propensity-matched analysis', Journal of Clinical Oncology, vol. 32, no. 23, pp. 2449-2455. https://doi.org/10.1200/JCO.2013.50.8762
Landreneau, Rodney J. ; Normolle, Daniel P. ; Christie, Neil A. ; Awais, Omar ; Wizorek, Joseph J. ; Abbas, Ghulam ; Pennathur, Arjun ; Shende, Manisha ; Weksler, Benny ; Luketich, James D. ; Schuchert, Matthew J. / Recurrence and survival outcomes after anatomic segmentectomy versus lobectomy for clinical stage I non- Small-cell lung cancer : A propensity-matched analysis. In: Journal of Clinical Oncology. 2014 ; Vol. 32, No. 23. pp. 2449-2455.
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abstract = "Purpose: Although anatomic segmentectomy has been considered a compromised procedure by many surgeons, recent retrospective, single-institution series have demonstrated tumor recurrence and patient survival rates that approximate those achieved by lobectomy. The primary objective of this study was to use propensity score matching to compare outcomes after these anatomic resection approaches for stage I non-small-cell lung cancer. Patients and Methods: A retrospective data set including 392 segmentectomy patients and 800 lobectomy patients was used to identify matched segmentectomy and lobectomy cohorts (n = 312 patients per group) using a propensity score matching algorithm that accounted for confounding effects of preoperative patient variables. Primary outcome variables included freedom from recurrence and overall survival. Factors affecting survival were assessed by Cox regression analysis and Kaplan-Meier estimates. Results: Perioperative mortality was 1.2{\%} in the segmentectomy group and 2.5{\%} in the lobectomy group (P = .38). At a mean follow-up of 5.4 years, comparing segmentectomy with lobectomy, no differences were noted in locoregional (5.5{\%} v 5.1{\%}, respectively; P = 1.00), distant (14.8{\%} v 11.6{\%}, respectively; P = .29), or overall recurrence rates (20.2{\%} v 16.7{\%}, respectively; P = .30). Furthermore, when comparing segmentectomy with lobectomy, no significant differences were noted in 5-year freedom from recurrence (70{\%} v 71{\%}, respectively; P = .467) or 5-year survival (54{\%} v 60{\%}, respectively; P = .258). Segmentectomy was not found to be an independent predictor of recurrence (hazard ratio, 1.11; 95{\%} CI, 0.87 to 1.40) or overall survival (hazard ratio, 1.17; 95{\%} CI, 0.89 to 1.52). Conclusion: In this large propensity-matched comparison, lobectomy was associated with modestly increased freedom from recurrence and overall survival, but the differences were not statistically significant. These results will need further validation by prospective, randomized trials (eg, Cancer and Leukemia Group B 140503 trial).",
author = "Landreneau, {Rodney J.} and Normolle, {Daniel P.} and Christie, {Neil A.} and Omar Awais and Wizorek, {Joseph J.} and Ghulam Abbas and Arjun Pennathur and Manisha Shende and Benny Weksler and Luketich, {James D.} and Schuchert, {Matthew J.}",
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T1 - Recurrence and survival outcomes after anatomic segmentectomy versus lobectomy for clinical stage I non- Small-cell lung cancer

T2 - A propensity-matched analysis

AU - Landreneau, Rodney J.

AU - Normolle, Daniel P.

AU - Christie, Neil A.

AU - Awais, Omar

AU - Wizorek, Joseph J.

AU - Abbas, Ghulam

AU - Pennathur, Arjun

AU - Shende, Manisha

AU - Weksler, Benny

AU - Luketich, James D.

AU - Schuchert, Matthew J.

PY - 2014/8/10

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N2 - Purpose: Although anatomic segmentectomy has been considered a compromised procedure by many surgeons, recent retrospective, single-institution series have demonstrated tumor recurrence and patient survival rates that approximate those achieved by lobectomy. The primary objective of this study was to use propensity score matching to compare outcomes after these anatomic resection approaches for stage I non-small-cell lung cancer. Patients and Methods: A retrospective data set including 392 segmentectomy patients and 800 lobectomy patients was used to identify matched segmentectomy and lobectomy cohorts (n = 312 patients per group) using a propensity score matching algorithm that accounted for confounding effects of preoperative patient variables. Primary outcome variables included freedom from recurrence and overall survival. Factors affecting survival were assessed by Cox regression analysis and Kaplan-Meier estimates. Results: Perioperative mortality was 1.2% in the segmentectomy group and 2.5% in the lobectomy group (P = .38). At a mean follow-up of 5.4 years, comparing segmentectomy with lobectomy, no differences were noted in locoregional (5.5% v 5.1%, respectively; P = 1.00), distant (14.8% v 11.6%, respectively; P = .29), or overall recurrence rates (20.2% v 16.7%, respectively; P = .30). Furthermore, when comparing segmentectomy with lobectomy, no significant differences were noted in 5-year freedom from recurrence (70% v 71%, respectively; P = .467) or 5-year survival (54% v 60%, respectively; P = .258). Segmentectomy was not found to be an independent predictor of recurrence (hazard ratio, 1.11; 95% CI, 0.87 to 1.40) or overall survival (hazard ratio, 1.17; 95% CI, 0.89 to 1.52). Conclusion: In this large propensity-matched comparison, lobectomy was associated with modestly increased freedom from recurrence and overall survival, but the differences were not statistically significant. These results will need further validation by prospective, randomized trials (eg, Cancer and Leukemia Group B 140503 trial).

AB - Purpose: Although anatomic segmentectomy has been considered a compromised procedure by many surgeons, recent retrospective, single-institution series have demonstrated tumor recurrence and patient survival rates that approximate those achieved by lobectomy. The primary objective of this study was to use propensity score matching to compare outcomes after these anatomic resection approaches for stage I non-small-cell lung cancer. Patients and Methods: A retrospective data set including 392 segmentectomy patients and 800 lobectomy patients was used to identify matched segmentectomy and lobectomy cohorts (n = 312 patients per group) using a propensity score matching algorithm that accounted for confounding effects of preoperative patient variables. Primary outcome variables included freedom from recurrence and overall survival. Factors affecting survival were assessed by Cox regression analysis and Kaplan-Meier estimates. Results: Perioperative mortality was 1.2% in the segmentectomy group and 2.5% in the lobectomy group (P = .38). At a mean follow-up of 5.4 years, comparing segmentectomy with lobectomy, no differences were noted in locoregional (5.5% v 5.1%, respectively; P = 1.00), distant (14.8% v 11.6%, respectively; P = .29), or overall recurrence rates (20.2% v 16.7%, respectively; P = .30). Furthermore, when comparing segmentectomy with lobectomy, no significant differences were noted in 5-year freedom from recurrence (70% v 71%, respectively; P = .467) or 5-year survival (54% v 60%, respectively; P = .258). Segmentectomy was not found to be an independent predictor of recurrence (hazard ratio, 1.11; 95% CI, 0.87 to 1.40) or overall survival (hazard ratio, 1.17; 95% CI, 0.89 to 1.52). Conclusion: In this large propensity-matched comparison, lobectomy was associated with modestly increased freedom from recurrence and overall survival, but the differences were not statistically significant. These results will need further validation by prospective, randomized trials (eg, Cancer and Leukemia Group B 140503 trial).

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