The Survival Advantage of Lobectomy over Wedge Resection Lessens as Health-Related Life Expectancy Decreases
Introduction: Patients with early-stage NSCLC typically must choose between a surgery with superior local control (lobectomy) or one that preserves lung parenchyma (wedge). Recognizing that many patients with cancer have competing mortality risks unrelated to cancer, we investigated whether an estab...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-03-01
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| Series: | JTO Clinical and Research Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666364321000023 |
| _version_ | 1818562200237768704 |
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| author | Michelle C. Salazar, MD Maureen E. Canavan, PhD Samantha L. Walters, BS Sitaram Chilakamarry, MD Theresa Ermer, MD Justin D. Blasberg, MD James B. Yu, MD, MHS Cary P. Gross, MD Daniel J. Boffa, MD |
| author_facet | Michelle C. Salazar, MD Maureen E. Canavan, PhD Samantha L. Walters, BS Sitaram Chilakamarry, MD Theresa Ermer, MD Justin D. Blasberg, MD James B. Yu, MD, MHS Cary P. Gross, MD Daniel J. Boffa, MD |
| author_sort | Michelle C. Salazar, MD |
| collection | DOAJ |
| description | Introduction: Patients with early-stage NSCLC typically must choose between a surgery with superior local control (lobectomy) or one that preserves lung parenchyma (wedge). Recognizing that many patients with cancer have competing mortality risks unrelated to cancer, we investigated whether an established model of predicting life expectancy could be used to identify patients with stage I NSCLC for whom survival after wedge is not different from lobectomy. Methods: A retrospective cohort study using the National Cancer Institute’s Surveillance Epidemiology and End Results—Medicare was performed to evaluate survival among treatment-naive patients, diagnosed 2005–2015, who underwent lobectomy or wedge for stage I (≤2 cm tumors) NSCLC. Comorbidity-related life expectancy (CR-LE) was estimated using a standard life-table approach based on comorbid conditions, sex, and age. Cox models and perioperative complications were stratified by 5-year CR-LE. Results: A total of 4560 patients (median age 74, interquartile range 70–78) were identified. CR-LE was greater than or equal to 5 years for 4016 patients (wedge = 23%). CR-LE was less than 5 years for 544 patients (wedge = 41%). Among patients with CR-LE greater than or equal to 5, wedge resection was associated with higher risk of mortality than lobectomy (hazard ratio: 1.68, 95% confidence interval: 1.52–1.86, p < 0.001). For those with CR-LE less than 5, there was no significant difference in mortality risk between lobectomy and wedge (hazard ratio: 1.19, 95% confidence interval: 0.96–1.47; p = 0.11). CR-LE less than five patients who underwent a lobectomy had higher 90-day mortality compared with wedge (9% versus 4%, p = 0.04). Conclusion: The survival advantage of lobectomy over wedge for stage I NSCLC seems to dissipate among patients with shorter life expectancy owing to age and comorbidities. Wedge resection may be a reasonable option for patients at high risk of dying from non–cancer-related causes. |
| first_indexed | 2024-12-14T01:00:35Z |
| format | Article |
| id | doaj.art-bba755ee2fef4543b78b298aded765c4 |
| institution | Directory Open Access Journal |
| issn | 2666-3643 |
| language | English |
| last_indexed | 2024-12-14T01:00:35Z |
| publishDate | 2021-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTO Clinical and Research Reports |
| spelling | doaj.art-bba755ee2fef4543b78b298aded765c42022-12-21T23:23:17ZengElsevierJTO Clinical and Research Reports2666-36432021-03-0123100143The Survival Advantage of Lobectomy over Wedge Resection Lessens as Health-Related Life Expectancy DecreasesMichelle C. Salazar, MD0Maureen E. Canavan, PhD1Samantha L. Walters, BS2Sitaram Chilakamarry, MD3Theresa Ermer, MD4Justin D. Blasberg, MD5James B. Yu, MD, MHS6Cary P. Gross, MD7Daniel J. Boffa, MD8Department of Surgery, Yale University School of Medicine, New Haven, Connecticut; National Clinician Scholars Program, Yale University School of Medicine, New Haven, ConnecticutCancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Section of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, ConnecticutSection of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, ConnecticutDivision of Colon and Rectal Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, TexasFaculty of Medicine, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, GermanySection of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, ConnecticutDepartment of Therapeutic Radiology, Yale University School of Medicine, New Haven, ConnecticutNational Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut; Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Department of Internal Medicine, Yale University School of Medicine, New Haven, ConnecticutSection of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut; Corresponding author. Address for correspondence: Daniel J. Boffa, MD, Department of Surgery, Yale University School of Medicine, New Haven, P.O. Box 208062, New Haven, CT 06520-8062.Introduction: Patients with early-stage NSCLC typically must choose between a surgery with superior local control (lobectomy) or one that preserves lung parenchyma (wedge). Recognizing that many patients with cancer have competing mortality risks unrelated to cancer, we investigated whether an established model of predicting life expectancy could be used to identify patients with stage I NSCLC for whom survival after wedge is not different from lobectomy. Methods: A retrospective cohort study using the National Cancer Institute’s Surveillance Epidemiology and End Results—Medicare was performed to evaluate survival among treatment-naive patients, diagnosed 2005–2015, who underwent lobectomy or wedge for stage I (≤2 cm tumors) NSCLC. Comorbidity-related life expectancy (CR-LE) was estimated using a standard life-table approach based on comorbid conditions, sex, and age. Cox models and perioperative complications were stratified by 5-year CR-LE. Results: A total of 4560 patients (median age 74, interquartile range 70–78) were identified. CR-LE was greater than or equal to 5 years for 4016 patients (wedge = 23%). CR-LE was less than 5 years for 544 patients (wedge = 41%). Among patients with CR-LE greater than or equal to 5, wedge resection was associated with higher risk of mortality than lobectomy (hazard ratio: 1.68, 95% confidence interval: 1.52–1.86, p < 0.001). For those with CR-LE less than 5, there was no significant difference in mortality risk between lobectomy and wedge (hazard ratio: 1.19, 95% confidence interval: 0.96–1.47; p = 0.11). CR-LE less than five patients who underwent a lobectomy had higher 90-day mortality compared with wedge (9% versus 4%, p = 0.04). Conclusion: The survival advantage of lobectomy over wedge for stage I NSCLC seems to dissipate among patients with shorter life expectancy owing to age and comorbidities. Wedge resection may be a reasonable option for patients at high risk of dying from non–cancer-related causes.http://www.sciencedirect.com/science/article/pii/S2666364321000023Non–small cell lung cancerStage ILobectomyWedgeMortality |
| spellingShingle | Michelle C. Salazar, MD Maureen E. Canavan, PhD Samantha L. Walters, BS Sitaram Chilakamarry, MD Theresa Ermer, MD Justin D. Blasberg, MD James B. Yu, MD, MHS Cary P. Gross, MD Daniel J. Boffa, MD The Survival Advantage of Lobectomy over Wedge Resection Lessens as Health-Related Life Expectancy Decreases JTO Clinical and Research Reports Non–small cell lung cancer Stage I Lobectomy Wedge Mortality |
| title | The Survival Advantage of Lobectomy over Wedge Resection Lessens as Health-Related Life Expectancy Decreases |
| title_full | The Survival Advantage of Lobectomy over Wedge Resection Lessens as Health-Related Life Expectancy Decreases |
| title_fullStr | The Survival Advantage of Lobectomy over Wedge Resection Lessens as Health-Related Life Expectancy Decreases |
| title_full_unstemmed | The Survival Advantage of Lobectomy over Wedge Resection Lessens as Health-Related Life Expectancy Decreases |
| title_short | The Survival Advantage of Lobectomy over Wedge Resection Lessens as Health-Related Life Expectancy Decreases |
| title_sort | survival advantage of lobectomy over wedge resection lessens as health related life expectancy decreases |
| topic | Non–small cell lung cancer Stage I Lobectomy Wedge Mortality |
| url | http://www.sciencedirect.com/science/article/pii/S2666364321000023 |
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