Sublobar resection is associated with decreased survival for patients with early stage large-cell neuroendocrine carcinoma of the lung.
Publication/Presentation Date
10-1-2019
Abstract
OBJECTIVES: Sublobar resection (SLR) for early non-small-cell lung carcinoma (NSCLC) has been shown to have a survival rate similar to that of lobectomy. Large-cell neuroendocrine carcinoma (LCNEC) of the lung, although treated like an NSCLC, has a poor prognosis compared to NSCLC. We sought to determine if outcomes are poor in patients with early stage LCNEC treated with SLR versus lobectomy.
METHODS: We searched for patients with pathological stage I LCNEC ≤3 cm within the National Cancer Database between 2004 and 2014. Propensity score matching was used to compare the 5-year overall survival rate of patients having SLR (wedge or segmentectomy) to that of patients having a lobectomy. Patients were matched for age, node sampling, comorbidity score, tumour size, insurance status and other factors. Patients who received neoadjuvant therapy were excluded. Kaplan-Meier methods were used for analysis.
RESULTS: A total of 1011 patients met the inclusion criteria: 263 were treated with SLR (223 wedges and 40 segmentectomies) and 748 patients, with lobectomy. Patients who received SLR were older, had more comorbidities and smaller tumours. On unadjusted Kaplan-Meier analysis, patients who had SLR had decreased 5-year overall survival compared to those who had a lobectomy (37.9% vs 56.6%, P < 0.001). Propensity score matching (1:1) across 12 demographic and tumour variables yielded 185 patients per group with 34 segmentectomies and 151 wedge resections in the SLR cohort. On Kaplan-Meier analysis of the matched cohort, patients who had SLR had a worse 5-year overall survival rate compared to those who had a lobectomy (41.5% vs 60.3%; P = 0.001).
CONCLUSIONS: SLR for early stage LCNEC is associated with a lower 5-year overall survival rate compared to lobectomy on unadjusted and propensity matched analyses.
Volume
29
Issue
4
First Page
517
Last Page
524
ISSN
1569-9285
Published In/Presented At
Lutfi, W., Schuchert, M. J., Dhupar, R., Sarkaria, I., Christie, N. A., Yang, C. J., Deng, J. Z., Luketich, J. D., & Okusanya, O. T. (2019). Sublobar resection is associated with decreased survival for patients with early stage large-cell neuroendocrine carcinoma of the lung. Interactive cardiovascular and thoracic surgery, 29(4), 517–524. https://doi.org/10.1093/icvts/ivz140
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
31177277
Department(s)
Administration and Leadership
Document Type
Article