Predictors and outcomes of limited resection for early-stage non-small cell lung cancer

Sarah E. Billmeier, John Z. Ayanian, Alan M. Zaslavsky, David R. Nerenz, Michael T. Jaklitsch, Selwyn O. Rogers

Research output: Contribution to journalArticle

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Abstract

Background Lobectomy is considered the standard treatment for early-stage non-small cell lung cancer (NSCLC); however, more limited resections are commonly performed. We examined patient and surgeon factors associated with limited resection and compared postoperative and long-term outcomes between sublobar and lobar resections. Methods A population-and health system-based sample of patients newly diagnosed with stage I or II NSCLC between 2003 and 2005 in five geographically defined regions, five integrated health-care delivery systems, and 15 Veterans Affairs hospitals was observed for a median of 55 months, through May 31, 2010. Predictors of limited resection and postoperative outcomes were compared using unadjusted and propensity score-weighted analyses. All P values are from two-sided tests. Results One hundred fifty-five (23%) patients underwent limited resection and 524 (77%) underwent lobectomy. In adjusted analyses of patient-specific factors, smaller tumor size (P =. 004), coverage by Medicare or Medicaid, no insurance or unknown insurance (P =. 02), more severe lung disease (P <. 001), and a history of stroke (P =. 049) were associated with receipt of limited resection. In adjusted analyses of surgeon characteristics, thoracic surgery specialty (P =. 02), non-fee-for-service compensation (P =. 008), and National Cancer Institute cancer center designation (P =. 006) were associated with higher odds of limited resection. Unadjusted 30-day mortality was higher with limited resection than with lobectomy (7.1% vs 1.9%, difference = 5.2%, 95% confidence interval [CI] = 1.5% to 10.8%, P =. 003), and the adjusted difference was not statistically significant (6.5% vs 2.9%, difference = 3.6%, 95% CI =-.1% to 9.2%, P =. 09). Postoperative complications did not differ by type of surgery (all P >. 05). Over the course of the study, a non-statistically significant trend toward improved long-term survival was evident for lobectomy, compared with limited resection, in adjusted analyses (hazard ratio of death = 1.35 for limited resection, 95% CI = 0.99 to 1.84, P =. 05). Conclusions Evidence is statistically inconclusive but suggestive that lobectomy, compared with limited resection, is associated with increased long-term survival for early-stage lung cancer. Clinical, socioeconomic, and surgeon factors appear to be associated with the choice of surgical resection.

Original languageEnglish (US)
Pages (from-to)1621-1629
Number of pages9
JournalJournal of the National Cancer Institute
Volume103
Issue number21
DOIs
StatePublished - Nov 2 2011
Externally publishedYes

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Non-Small Cell Lung Carcinoma
Insurance
Integrated Delivery of Health Care
Veterans Hospitals
Propensity Score
Survival
Medicaid
Medicare
Lung Diseases
Lung Neoplasms
Health
Population
Neoplasms
Surgeons
Therapeutics

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Billmeier, S. E., Ayanian, J. Z., Zaslavsky, A. M., Nerenz, D. R., Jaklitsch, M. T., & Rogers, S. O. (2011). Predictors and outcomes of limited resection for early-stage non-small cell lung cancer. Journal of the National Cancer Institute, 103(21), 1621-1629. https://doi.org/10.1093/jnci/djr387

Predictors and outcomes of limited resection for early-stage non-small cell lung cancer. / Billmeier, Sarah E.; Ayanian, John Z.; Zaslavsky, Alan M.; Nerenz, David R.; Jaklitsch, Michael T.; Rogers, Selwyn O.

In: Journal of the National Cancer Institute, Vol. 103, No. 21, 02.11.2011, p. 1621-1629.

Research output: Contribution to journalArticle

Billmeier, SE, Ayanian, JZ, Zaslavsky, AM, Nerenz, DR, Jaklitsch, MT & Rogers, SO 2011, 'Predictors and outcomes of limited resection for early-stage non-small cell lung cancer', Journal of the National Cancer Institute, vol. 103, no. 21, pp. 1621-1629. https://doi.org/10.1093/jnci/djr387
Billmeier SE, Ayanian JZ, Zaslavsky AM, Nerenz DR, Jaklitsch MT, Rogers SO. Predictors and outcomes of limited resection for early-stage non-small cell lung cancer. Journal of the National Cancer Institute. 2011 Nov 2;103(21):1621-1629. https://doi.org/10.1093/jnci/djr387
Billmeier, Sarah E. ; Ayanian, John Z. ; Zaslavsky, Alan M. ; Nerenz, David R. ; Jaklitsch, Michael T. ; Rogers, Selwyn O. / Predictors and outcomes of limited resection for early-stage non-small cell lung cancer. In: Journal of the National Cancer Institute. 2011 ; Vol. 103, No. 21. pp. 1621-1629.
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abstract = "Background Lobectomy is considered the standard treatment for early-stage non-small cell lung cancer (NSCLC); however, more limited resections are commonly performed. We examined patient and surgeon factors associated with limited resection and compared postoperative and long-term outcomes between sublobar and lobar resections. Methods A population-and health system-based sample of patients newly diagnosed with stage I or II NSCLC between 2003 and 2005 in five geographically defined regions, five integrated health-care delivery systems, and 15 Veterans Affairs hospitals was observed for a median of 55 months, through May 31, 2010. Predictors of limited resection and postoperative outcomes were compared using unadjusted and propensity score-weighted analyses. All P values are from two-sided tests. Results One hundred fifty-five (23{\%}) patients underwent limited resection and 524 (77{\%}) underwent lobectomy. In adjusted analyses of patient-specific factors, smaller tumor size (P =. 004), coverage by Medicare or Medicaid, no insurance or unknown insurance (P =. 02), more severe lung disease (P <. 001), and a history of stroke (P =. 049) were associated with receipt of limited resection. In adjusted analyses of surgeon characteristics, thoracic surgery specialty (P =. 02), non-fee-for-service compensation (P =. 008), and National Cancer Institute cancer center designation (P =. 006) were associated with higher odds of limited resection. Unadjusted 30-day mortality was higher with limited resection than with lobectomy (7.1{\%} vs 1.9{\%}, difference = 5.2{\%}, 95{\%} confidence interval [CI] = 1.5{\%} to 10.8{\%}, P =. 003), and the adjusted difference was not statistically significant (6.5{\%} vs 2.9{\%}, difference = 3.6{\%}, 95{\%} CI =-.1{\%} to 9.2{\%}, P =. 09). Postoperative complications did not differ by type of surgery (all P >. 05). Over the course of the study, a non-statistically significant trend toward improved long-term survival was evident for lobectomy, compared with limited resection, in adjusted analyses (hazard ratio of death = 1.35 for limited resection, 95{\%} CI = 0.99 to 1.84, P =. 05). Conclusions Evidence is statistically inconclusive but suggestive that lobectomy, compared with limited resection, is associated with increased long-term survival for early-stage lung cancer. Clinical, socioeconomic, and surgeon factors appear to be associated with the choice of surgical resection.",
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AU - Jaklitsch, Michael T.

AU - Rogers, Selwyn O.

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N2 - Background Lobectomy is considered the standard treatment for early-stage non-small cell lung cancer (NSCLC); however, more limited resections are commonly performed. We examined patient and surgeon factors associated with limited resection and compared postoperative and long-term outcomes between sublobar and lobar resections. Methods A population-and health system-based sample of patients newly diagnosed with stage I or II NSCLC between 2003 and 2005 in five geographically defined regions, five integrated health-care delivery systems, and 15 Veterans Affairs hospitals was observed for a median of 55 months, through May 31, 2010. Predictors of limited resection and postoperative outcomes were compared using unadjusted and propensity score-weighted analyses. All P values are from two-sided tests. Results One hundred fifty-five (23%) patients underwent limited resection and 524 (77%) underwent lobectomy. In adjusted analyses of patient-specific factors, smaller tumor size (P =. 004), coverage by Medicare or Medicaid, no insurance or unknown insurance (P =. 02), more severe lung disease (P <. 001), and a history of stroke (P =. 049) were associated with receipt of limited resection. In adjusted analyses of surgeon characteristics, thoracic surgery specialty (P =. 02), non-fee-for-service compensation (P =. 008), and National Cancer Institute cancer center designation (P =. 006) were associated with higher odds of limited resection. Unadjusted 30-day mortality was higher with limited resection than with lobectomy (7.1% vs 1.9%, difference = 5.2%, 95% confidence interval [CI] = 1.5% to 10.8%, P =. 003), and the adjusted difference was not statistically significant (6.5% vs 2.9%, difference = 3.6%, 95% CI =-.1% to 9.2%, P =. 09). Postoperative complications did not differ by type of surgery (all P >. 05). Over the course of the study, a non-statistically significant trend toward improved long-term survival was evident for lobectomy, compared with limited resection, in adjusted analyses (hazard ratio of death = 1.35 for limited resection, 95% CI = 0.99 to 1.84, P =. 05). Conclusions Evidence is statistically inconclusive but suggestive that lobectomy, compared with limited resection, is associated with increased long-term survival for early-stage lung cancer. Clinical, socioeconomic, and surgeon factors appear to be associated with the choice of surgical resection.

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