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Mohamed K Hussein

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    OA06 - Early Stage Lung Cancer: Outcomes and Interventions (ID 902)

    • Event: WCLC 2018
    • Type: Oral Abstract Session
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 13:30 - 15:00, Room 202 BD
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      OA06.03 - Sublobar Resection is Equivalent to Lobectomy for Screen Detected Lung Cancer (ID 13968)

      13:50 - 14:00  |  Author(s): Mohamed K Hussein

      • Abstract
      • Presentation


      Despite the lack of survival data from modern, ongoing randomized clinical trials (CALGB 140503, JCOG 0802), sublobar resection (SLR) is increasingly offered to patients with small, peripheral lung cancers. In particular, SLR may be an attractive surgical strategy for screen detected lung cancers, some of which may be less biologically aggressive than cancers detected by other means. Utilizing prospective data collected from patients undergoing surgery in the National Lung Screening Trial (NLST), we sought to determine whether the extent of resection affected survival for patients with screen detected lung cancer.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      The NLST database was queried for patients who underwent surgical resection for confirmed lung cancer. Numerical variables were compared using Mann-Whitney U test. Categorical variables were compared using Chi-squared test. Propensity score matching analysis (lobectomy versus sublobar resection) controlling for age, gender, race, tumor size, and stage was performed (nearest neighbor, 1:1, matching with no replacement, caliper 0.2). Overall survival (OS) and cancer specific survival (CSS) were compared using log rank test in Kaplan Meier curves.

      4c3880bb027f159e801041b1021e88e8 Result

      Among 1,029 patients who underwent resection for lung cancer, we identified 821 patients (80%) who had lobectomy and 166 patients (16%) who had SLR, among whom the majority (n=114, 69%) had wedge resection. Patients who underwent SLR were older (64 vs. 61, p=0.66), more likely to be female (53% vs. 41%, p=0.004), had smaller tumors (2 cm vs. 4.5 cm, p<0.001), and were more likely to be stage I (80% vs. 75%, p=0.001). At five years, for stage I patients undergoing SLR (n=129) there was no difference in OS (77% vs. 77%, p=0.889) or CSS (83% vs. 83%, p=0.959) compared to patients undergoing lobectomy (n=613). In order to more accurately compare surgical outcomes, we propensity matched 134 patients from each group undergoing SLR and lobectomy. Among these matched groups, there were no differences in age, gender, histology, or stage. Postoperatively, patients undergoing SLR had less total complications (22% vs. 32%, p=0.05) than those undergoing lobectomy (HR 0.59, CI 0.38-0.94). In matched patients at five years, there was no difference in OS (67% vs. 70%, p=0.629) or CSS (74% vs. 74%, p=0.980) for patients undergoing SLR compared to those undergoing lobectomy.

      8eea62084ca7e541d918e823422bd82e Conclusion

      For patients with screen detected lung cancer, SLR confers equivalent survival to lobectomy. By decreasing perioperative complications and potentially preserving lung function, SLR may provide distinct advantages in a screen detected lung cancer patient cohort.


      Information from this presentation has been removed upon request of the author.

      Information from this presentation has been removed upon request of the author.