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The Role of Extent of Surgical Resection and Lymph Node Assessment for Clinical Stage I Pulmonary Lepidic Adenocarcinoma: An Analysis of 1991 Patients.

Publication ,  Journal Article
Cox, ML; Yang, C-FJ; Speicher, PJ; Anderson, KL; Fitch, ZW; Gu, L; Davis, RP; Wang, X; D'Amico, TA; Hartwig, MG; Harpole, DH; Berry, MF
Published in: J Thorac Oncol
April 2017

BACKGROUND: This study examined the association of extent of lung resection, pathologic nodal evaluation, and survival for patients with clinical stage I (cT1-2N0M0) adenocarcinoma with lepidic histologic features in the National Cancer Data Base. METHODS: The association between extent of surgical resection and long-term survival for patients in the National Cancer Data Base with clinical stage I lepidic adenocarcinoma who underwent lobectomy or sublobar resection was evaluated using Kaplan-Meier and Cox proportional hazards regression analyses. RESULTS: Of the 1991 patients with cT1-2N0M0 lepidic adenocarcinoma who met the study criteria, 1544 underwent lobectomy and 447 underwent sublobar resection. Patients treated with sublobar resection were older, more likely to be female, and had higher Charlson/Deyo comorbidity scores, but they had smaller tumors and lower T status. Of the patients treated with lobectomy, 6% (n = 92) were upstaged because of positive nodal disease, with a median of seven lymph nodes sampled (interquartile range 4-10). In an analysis of the entire cohort, lobectomy was associated with a significant survival advantage over sublobar resection in univariate analysis (median survival 9.2 versus 7.5 years, p = 0.022, 5-year survival 70.5% versus 67.8%) and after multivariable adjustment (hazard ratio = 0.81, 95% confidence interval: 0.68-0.95, p = 0.011). However, lobectomy was no longer independently associated with improved survival when compared with sublobar resection (hazard ratio = 0.99, 95% confidence interval: 0.77-1.27, p = 0.905) in a multivariable analysis of a subset of patients in which only those patients who had undergone a sublobar resection including lymph node sampling were compared with patients treated with lobectomy. CONCLUSIONS: Surgeons treating patients with stage I lung adenocarcinoma with lepidic features should cautiously utilize sublobar resection rather than lobectomy, and they must always perform adequate pathologic lymph node evaluation.

Duke Scholars

Published In

J Thorac Oncol

DOI

EISSN

1556-1380

Publication Date

April 2017

Volume

12

Issue

4

Start / End Page

689 / 696

Location

United States

Related Subject Headings

  • Survival Rate
  • Retrospective Studies
  • Prognosis
  • Pneumonectomy
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Lymph Nodes
  • Lung Neoplasms
 

Citation

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Chicago
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MLA
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Cox, M. L., Yang, C.-F., Speicher, P. J., Anderson, K. L., Fitch, Z. W., Gu, L., … Berry, M. F. (2017). The Role of Extent of Surgical Resection and Lymph Node Assessment for Clinical Stage I Pulmonary Lepidic Adenocarcinoma: An Analysis of 1991 Patients. J Thorac Oncol, 12(4), 689–696. https://doi.org/10.1016/j.jtho.2017.01.003
Cox, Morgan L., Chi-Fu Jeffrey Yang, Paul J. Speicher, Kevin L. Anderson, Zachary W. Fitch, Lin Gu, Robert Patrick Davis, et al. “The Role of Extent of Surgical Resection and Lymph Node Assessment for Clinical Stage I Pulmonary Lepidic Adenocarcinoma: An Analysis of 1991 Patients.J Thorac Oncol 12, no. 4 (April 2017): 689–96. https://doi.org/10.1016/j.jtho.2017.01.003.
Cox ML, Yang C-FJ, Speicher PJ, Anderson KL, Fitch ZW, Gu L, et al. The Role of Extent of Surgical Resection and Lymph Node Assessment for Clinical Stage I Pulmonary Lepidic Adenocarcinoma: An Analysis of 1991 Patients. J Thorac Oncol. 2017 Apr;12(4):689–96.
Cox, Morgan L., et al. “The Role of Extent of Surgical Resection and Lymph Node Assessment for Clinical Stage I Pulmonary Lepidic Adenocarcinoma: An Analysis of 1991 Patients.J Thorac Oncol, vol. 12, no. 4, Apr. 2017, pp. 689–96. Pubmed, doi:10.1016/j.jtho.2017.01.003.
Cox ML, Yang C-FJ, Speicher PJ, Anderson KL, Fitch ZW, Gu L, Davis RP, Wang X, D’Amico TA, Hartwig MG, Harpole DH, Berry MF. The Role of Extent of Surgical Resection and Lymph Node Assessment for Clinical Stage I Pulmonary Lepidic Adenocarcinoma: An Analysis of 1991 Patients. J Thorac Oncol. 2017 Apr;12(4):689–696.
Journal cover image

Published In

J Thorac Oncol

DOI

EISSN

1556-1380

Publication Date

April 2017

Volume

12

Issue

4

Start / End Page

689 / 696

Location

United States

Related Subject Headings

  • Survival Rate
  • Retrospective Studies
  • Prognosis
  • Pneumonectomy
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Lymph Nodes
  • Lung Neoplasms