Study Evaluates Surgical Options for NSCLC Tumors Measuring at Least 2 cm

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For patients with tumors larger than 1 cm, but no larger than 2 cm, who are not amenable to lobectomy, segmentectomy should be recommended.
For patients with tumors larger than 1 cm, but no larger than 2 cm, who are not amenable to lobectomy, segmentectomy should be recommended.

For patients with non-small cell lung cancer (NSCLC) tumors smaller than 1 cm and tumors between 1 cm and 2 cm, lobectomy resulted in better survival than sublobar resection, a study published in the Journal of Clinical Oncology has shown.1

The lung cancer staging project has proposed that T1a NSCLC tumors, which are no bigger than 2 cm, should be further classified into 2 groups: no larger than 1 cm and larger than 1 cm but no bigger than 2 cm. Researchers investigated outcomes after 3 different surgical procedures for the 2 tumor size groups.

For this population-based study, investigators analyzed data from 15,760 patients with T1aN0M0 NSCLC who underwent surgical resection and were included in the Surveillance, Epidemiology, and End Results (SEER) database. Lung cancer-specific survival and overall survival were compared among patients after undergoing lobectomy, segmentectomy, and wedge resection.

Both overall survival and lung cancer-specific survival were better after lobectomy versus segmentectomy or wedge resection in patients with tumors no larger than 1 cm and those with tumors between 1 and 2 cm.

After adjusting for multiple factors, researchers found that segmentectomy and wedge resection were independently associated with poorer overall survival and lung cancer-specific survival for both tumor size groups.

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The study demonstrated that patients with tumors between 1 and 2 cm who underwent wedge resection had poorer overall and lung cancer-specific survival versus sublobar resection, though similar survival rates were observed for patients with NSCLC tumors no larger than 1 cm.

The findings suggest that for patients with tumors larger than 1 cm, but no larger than 2 cm, who are not amenable to lobectomy, segmentectomy should be recommended. For patients with tumors no larger than 1 cm, surgeons should weigh their surgical skills and the patient profile to decide between segmentectomy and wedge resection.                                     

Reference

1. Dai C, Shen J, Ren Y, et al. Choice of surgical procedure for patients with NSCLC ≤ 1 cm or > 1 to 2 cm among lobectomy, segmentectomy, and wedge resection: a population-based study. J Clin Oncol. 2016 Jul 5. doi: 10.1200/JCO.2015.64.6729. [Epub ahead of print]

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