In the Journals

Lobectomy superior to sublobar resection for elderly patients with early-stage NSCLC

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December 5, 2014

Lobectomy conferred better outcomes than sublobar resection in elderly patients with early-stage non-small cell lung cancer, according to results of a SEER analysis.

Incidence of early-stage non–small cell lung cancer among elderly individuals is expected to increase considerably due to demographic trends and the increased use of CT screening. However, the most common NSCLC treatments have not been compared in recent trials, according to background information provided by researchers.

Lung cancer is one of the most common and fatal cancers, and for the foreseeable future it will be one of the major health epidemics our country faces,” Shervin M. Shirvani, MD, of the department of radiation oncology at The University of Texas MD Anderson Cancer Center, said in a press release. “Yet, we don’t have strong evidence-based guidelines for how to best treat the disease — especially when it’s discovered early.”

Shirvani and colleagues used the SEER database to identify 9,093 patients with lung cancer aged 66 years and older (mean age, 75 years). Researchers extracted Medicare claims data to identify treatment strategies for all patients.

The researchers considered treatments administered within four months of diagnosis to be part of the initial treatment strategy. Treatments included lung surgery, classified as lobar or sublobar resection, and stereotactic ablative radiotherapy (SABR).

OS and lung cancer-specific survival served as endpoints.

Shirvani and colleagues determined 79.3% of patients underwent lobectomy, 16.5% underwent sublobar resection and 4.2% underwent SABR.

Patients who underwent lobectomy had the highest unadjusted 90-day mortality (4%), followed by those who underwent sublobar resection (3.7%; P=.79) and SABR (1.3%; P=.008), The 3-year unadjusted mortality rate was lowest for lobectomy (25%), followed by sublobar resection (35.3%; P<.001) and SABR (45.1%; P<.001).

Proportional hazards regression revealed shorter OS among patients who underwent sublobar resection compared with lobectomy (adjusted HR=1.5; 95% CI, 1.29-1.75). This trend persisted in propensity score-matching analysis for OS (adjusted HR=1.36; 95% CI, 1.17-1.58) and lung cancer-specific survival (adjusted HR=1.46; 95% CI, 1.13-1.9).

Results of proportional hazards regression showed patients who underwent SABR demonstrated superior OS within the first 6 months of diagnosis compared with those who underwent lobectomy (adjusted HR=0.45; 95% CI, 0.27-0.75), but SABR was associated with shorter OS in the period beyond 6 months post-diagnosis (adjusted HR=1.66; 95% CI, 1.39-1.99).

A propensity-score matching analysis of well-matched cohorts of patients who underwent SABR and lobectomy showed similar OS among both groups (adjusted HR=1.01; 95% CI, 0.74-1.38).

“The assumption was that, for an elderly patient with a number of comorbidities, the smaller surgery would be better than a whole lobectomy because there would be fewer surgical complications,” Shirvani said. “Yet, it appears that the ability to eradicate the cancer with the bigger surgery may be more important than minimizing surgical risk.”

Disclosure: The researchers report research funding from or consultant roles with Elekta Incorporated, GlaxoSmithKline, Reflexion Medical and Varian Medical Systems.

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