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

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35 Scopus citations

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

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    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