P177. Is a Completion Lobectomy After Sublobar Resection Warranted? Role of Type of Surgery Among Postoperatively Upstaged Clincal Stage 1A Lung Cancer
Presented During: Thoracic Poster Session II
Beth Israel Deaconess Medical Center, Harvard Medical School
Boston, MA
United States - Contact Me
Thoracic surgery fellow at the Beth Israel Medical Center - Harvard Medical School program.
Sunday, May 4, 2025: 9:00 AM - 4:00 PM
Seattle Convention Center | Summit
Room: Poster Area, Exhibit Hall
Description
Objective:
Clinical trials have shown a sublobar resection to be non-inferior to lobectomy for the treatment of clinical stage IA non-small cell lung cancer (NSCLC) without nodal disease on pre or intraoperative nodal sampling. However, patients may be understaged clinically and its unknown whether a completion lobectomy is beneficial among those with a sublobar resection in this setting.
Methods:
The National Cancer Database was queried for patients with surgically treated primary NSCLC for cStage IA1-2 without prior neoadjuvant treatment and stratified by those that were upstaged beyond pStage IA on final pathology. Patients were propensity-matched by surgical treatment to investigate the role of sublobar resection among upstaged using nearest-neighbor method. The outcome of interest was survival which was compared using Kaplan-Meier method. Univariable and multivariable analysis was performed using a Cox proportional hazards model.
Results:
Among patients that met inclusion criteria (n=159,692), 44,089 were upstaged beyond pStage 1A (38.1%). The most common reason for upstage was T status (n=5,431, 69.2%) followed by N (n=8,082, 18.4%), and both T and N (n=5,431, 12.4%). Age, male, non-white race, prior procedures, longer staging-surgical interval, upper lobe tumors, higher Charles-Deyo score, T1a or T1b were associated with increased odds of upstaging. Upstaging by T and N status had worse survival to those upstaged only by T or N status. Segmentectomy and lobectomy had similar overall survival rates after propensity matching for type of resection. Wedge resections were associated with higher positive margins, lower lymph nodes examined, higher need for adjuvant radiotherapy, and worse survival. Survival was similar by type of resection among those upstaged to pN1, pN2 or the composite of these after matching. Decreased survival was specific to wedge resections with ≤12 lymph nodes examined.
Conclusions:
A significant amount of patients with clinical stage 1A NSCLC are upstaged after resection. Preoperatively, clinical T stage serves as the main predictor of pathologic upstaging. Those upstaged have worsened survival, particularly if due to nodal metastases. The type of resection (lobectomy, segmentectomy, wedge) does not influence survival as long as an adequate lymph node dissection is performed. This does not support the need for a completion lobectomy after a sublobar resection for patients with pathological staging beyond stage 1A.
Authors
Miguel Leiva-Juarez (1), Sidhu Gangadharan (1), Jennifer Wilson (1), Richard Whyte (1), Michael Kent (1)
Institutions
(1) Beth Israel Deaconess Medical Center, Boston, MA
Clinical trials have shown a sublobar resection to be non-inferior to lobectomy for the treatment of clinical stage IA non-small cell lung cancer (NSCLC) without nodal disease on pre or intraoperative nodal sampling. However, patients may be understaged clinically and its unknown whether a completion lobectomy is beneficial among those with a sublobar resection in this setting.
Methods:
The National Cancer Database was queried for patients with surgically treated primary NSCLC for cStage IA1-2 without prior neoadjuvant treatment and stratified by those that were upstaged beyond pStage IA on final pathology. Patients were propensity-matched by surgical treatment to investigate the role of sublobar resection among upstaged using nearest-neighbor method. The outcome of interest was survival which was compared using Kaplan-Meier method. Univariable and multivariable analysis was performed using a Cox proportional hazards model.
Results:
Among patients that met inclusion criteria (n=159,692), 44,089 were upstaged beyond pStage 1A (38.1%). The most common reason for upstage was T status (n=5,431, 69.2%) followed by N (n=8,082, 18.4%), and both T and N (n=5,431, 12.4%). Age, male, non-white race, prior procedures, longer staging-surgical interval, upper lobe tumors, higher Charles-Deyo score, T1a or T1b were associated with increased odds of upstaging. Upstaging by T and N status had worse survival to those upstaged only by T or N status. Segmentectomy and lobectomy had similar overall survival rates after propensity matching for type of resection. Wedge resections were associated with higher positive margins, lower lymph nodes examined, higher need for adjuvant radiotherapy, and worse survival. Survival was similar by type of resection among those upstaged to pN1, pN2 or the composite of these after matching. Decreased survival was specific to wedge resections with ≤12 lymph nodes examined.
Conclusions:
A significant amount of patients with clinical stage 1A NSCLC are upstaged after resection. Preoperatively, clinical T stage serves as the main predictor of pathologic upstaging. Those upstaged have worsened survival, particularly if due to nodal metastases. The type of resection (lobectomy, segmentectomy, wedge) does not influence survival as long as an adequate lymph node dissection is performed. This does not support the need for a completion lobectomy after a sublobar resection for patients with pathological staging beyond stage 1A.
Authors
Miguel Leiva-Juarez (1), Sidhu Gangadharan (1), Jennifer Wilson (1), Richard Whyte (1), Michael Kent (1)
Institutions
(1) Beth Israel Deaconess Medical Center, Boston, MA