Limited Resection Not Equivalent to Lobectomy in Elderly NSCLC Patients

Limited resection is not as effective as lobectomy in older patients with early-stage non–small-cell lung cancer (NSCLC), according to a new study. Segmentectomy may provide similar outcomes, however, specifically in patients with adenocarcinoma.

Though NCCN guidelines currently recommend lobectomy with systematic lymph node sampling for stage IA disease, several recent observational studies have shown similar survival with limited resection (wedge resection or segmentectomy), in particular among older lung cancer patients. “Consequently, elective limited approaches are increasingly used for stage IA NSCLCs,” wrote study authors led by Rajwanth R. Veluswamy, MD, of Icahn School of Medicine at Mount Sinai in New York.

In the new study 2,008 patients with adenocarcinoma and 1,139 patients with squamous cell carcinoma were included from the SEER-Medicare registry; all were older than 65 years of age. Of those, 27% and 32%, respectively, underwent limited resection. Results of the analysis were published online ahead of print today in the Journal of Clinical Oncology.

Among adenocarcinoma patients, those treated with limited resection were more likely to be older (P < .001), less likely to be married (P < .001), had more comorbidities (P < .001), and had smaller tumors (P < .001). In squamous cell carcinoma patients, limited resection patients were again older (P = .04), more likely to be women (P = .004), and had higher comorbidity scores (P < .001).

Limited resection was not equivalent to lobectomy with regard to overall survival in invasive adenocarcinoma patients, with a hazard ratio (HR) of 1.21 (upper 95% confidence interval [CI], 1.34; an upper 95% CI of 1.25 or below was considered equivalent). It was also not equivalent in these patients with regard to lung cancer–specific survival, with an HR of 1.66 (upper 95% CI, 1.96). This was similar in squamous cell carcinoma patients, with an HR for overall survival of 1.21 (upper 95% CI, 1.39) and for lung cancer–specific survival of 1.41 (upper 95% CI, 1.79).

There was one subgroup that showed equivalence between treatments: patients with adenocarcinoma treated specifically with segmentectomy had equivalent overall survival, with an HR of 0.97 (upper 95% CI, 1.07), and cancer-specific survival, with an HR of 0.89 (upper 95% CI, 1.07), to those treated with lobectomy. This was not the case in squamous cell carcinoma patients.

“Our results highlight the importance of tumor histology as a determinant of long-term outcomes for patients with early-stage NSCLC,” the authors concluded. They noted the limitation of a lack of randomization, but wrote that these results are important especially given the increasing uptake of lung cancer screening “and the expected growth in the number of early-stage NSCLCs.”