Sublobar resection for node-negative lung cancer 2–5 cm in size

OBJECTIVES Sublobar resection (SLR) is an alternative to lobectomy for non-small-cell lung cancer (NSCLC). Outcomes following SLR for tumours >2 cm are not well described. We sought to determine the utilization of SLR for stage I tumours >2–5 cm in size and to determine predictors of outcome. METHODS We utilized the Surveillance, Epidemiology and End Results Program (SEER)-Medicare database to identify NSCLC patients with primary lung cancer ≥66 years old with stage I cancers >2–5 cm in size. We evaluated overall survival and cancer-specific survival among cohorts undergoing lobectomy versus SLR. Propensity score matching was performed. We compared patient characteristics and survival between groups. RESULTS For the study time period (2007–2012), among patients with tumours >2 cm and ≤5 cm (n = 4582), 3890 lobectomies (85%) and 692 SLR (15%) were performed. Patients undergoing SLR were older, had smaller tumours and more comorbidities. Patients undergoing lobectomy were much more likely to have any lymph nodes removed (95.6% vs 65.6%, P  10 nodes removed (29.6% vs 7.5%, P < 0.001). All-cause mortality [hazard ratio (HR) 1.65, confidence interval (CI) 1.48–1.85] and cancer-specific (HR 1.63, CI 1.29–2.06) mortality were higher following SLR. At 3 years, overall survival (60.9%, CI 57.0–64.6% vs 54.4%, CI 50.4–58.2%) and cancer-specific survival (87.3%, CI 83.5–90.3% vs 76.5%, CI 71.0–81.1%) favoured lobectomy over SLR. In propensity-matched groups, both all-cause (HR 1.27, CI 1.10–1.47) and cancer-specific (HR 1.54, CI 1.11–2.16) mortality rates were higher with SLR. CONCLUSIONS In pathologically staged patients, SLR appears inferior to lobectomy for stage I NSCLC 2–5 cm in size. SLR is associated with less extensive lymphadenectomy and with worse survival than lobectomy in this cohort of patients. However, the 76.5% 3-year cancer-specific survival in patients undergoing SLR may exceed that of other localized treatment options for NSCLC. As such, SLR may be an appropriate option for high-risk patients with carefully staged 2–5 cm N0 tumours.