Scholars@Duke publication: The Effect of Tumor Size and Histologic Findings on Outcomes After Segmentectomy vs Lobectomy for Clinically Node-Negative Non-Small Cell Lung Cancer.

The Effect of Tumor Size and Histologic Findings on Outcomes After Segmentectomy vs Lobectomy for Clinically Node-Negative Non-Small Cell Lung Cancer.

Publication , Journal Article

Raman, V; Jawitz, OK; Voigt, SL; Rhodin, KE; D'Amico, TA; Harpole, DH; Jeffrey Yang, C-F; Tong, BC

Published in: Chest

January 2021

BACKGROUND: The interaction between tumor size and the comparative prognosis of lobar and sublobar resection has been defined poorly. RESEARCH QUESTION: The purpose of this study was to characterize the relationship between tumor size and the receipt of segmentectomy or lobectomy in association with overall survival in patients with clinically node-negative non-small cell lung cancer (NSCLC). STUDY DESIGN AND METHODS: The 2004-2015 National Cancer Database (NCDB) was queried for patients with cT1-3N0M0 NSCLC who underwent segmentectomy or lobectomy without neoadjuvant therapy or missing survival data. The primary outcome was overall survival, which was evaluated using multivariate Cox proportional hazards including an interaction term between tumor size and type of surgery. RESULTS: A total of 143,040 patients were included: 135,446 (95%) underwent lobectomy and 7594 (5%) underwent segmentectomy. In multivariate Cox regression, a significant three-way interaction was found among tumor size, histologic results, and type of surgery (P < .001). When patients were stratified by histologic results, lobectomy was associated with significantly improved survival compared with segmentectomy beyond a tumor size of approximately 10 mm for adenocarcinoma and 15 mm for squamous cell carcinoma that was recapitulated in subgroup analyses. No interaction between tumor size and type of surgery was found for patients with neuroendocrine tumors. INTERPRETATION: In this NCDB study of patients with node-negative NSCLC, we found different tumor size thresholds, based on histologic results, that identified populations of patients who least and most benefitted from lobectomy compared with segmentectomy.

Duke Scholars

Author Vignesh Raman

Author Oliver Jawitz

Author Kristen Rhodin

Author Thomas Anthony D'Amico Surgery, Cardiovascular and Thoracic Surgery

Author David Harold Harpole Jr. Surgery, Cardiovascular and Thoracic Surgery

Author Betty Caroline Tong Surgery, Cardiovascular and Thoracic Surgery

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Published In

Chest

DOI

10.1016/j.chest.2020.06.066

EISSN

1931-3543

Publication Date

January 2021

Volume

159

Issue

Start / End Page

390 / 400

Location

United States

Related Subject Headings

Tumor Burden
Treatment Outcome
Survival Rate
Retrospective Studies
Respiratory System
Proportional Hazards Models
Pneumonectomy
Neoplasm Staging
Middle Aged
Male

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APA

Chicago

ICMJE

MLA

NLM

Raman, V., Jawitz, O. K., Voigt, S. L., Rhodin, K. E., D’Amico, T. A., Harpole, D. H., … Tong, B. C. (2021). The Effect of Tumor Size and Histologic Findings on Outcomes After Segmentectomy vs Lobectomy for Clinically Node-Negative Non-Small Cell Lung Cancer. Chest, 159(1), 390–400. https://doi.org/10.1016/j.chest.2020.06.066

Raman, Vignesh, Oliver K. Jawitz, Soraya L. Voigt, Kristen E. Rhodin, Thomas A. D’Amico, David H. Harpole, Chi-Fu Jeffrey Yang, and Betty C. Tong. “The Effect of Tumor Size and Histologic Findings on Outcomes After Segmentectomy vs Lobectomy for Clinically Node-Negative Non-Small Cell Lung Cancer.” Chest 159, no. 1 (January 2021): 390–400. https://doi.org/10.1016/j.chest.2020.06.066.

Raman V, Jawitz OK, Voigt SL, Rhodin KE, D’Amico TA, Harpole DH, et al. The Effect of Tumor Size and Histologic Findings on Outcomes After Segmentectomy vs Lobectomy for Clinically Node-Negative Non-Small Cell Lung Cancer. Chest. 2021 Jan;159(1):390–400.

Raman, Vignesh, et al. “The Effect of Tumor Size and Histologic Findings on Outcomes After Segmentectomy vs Lobectomy for Clinically Node-Negative Non-Small Cell Lung Cancer.” Chest, vol. 159, no. 1, Jan. 2021, pp. 390–400. Pubmed, doi:10.1016/j.chest.2020.06.066.

Raman V, Jawitz OK, Voigt SL, Rhodin KE, D’Amico TA, Harpole DH, Jeffrey Yang C-F, Tong BC. The Effect of Tumor Size and Histologic Findings on Outcomes After Segmentectomy vs Lobectomy for Clinically Node-Negative Non-Small Cell Lung Cancer. Chest. 2021 Jan;159(1):390–400.