Background:
A study found that patients with stage IA non–small-cell lung cancer (NSCLC) who underwent sublobar resection had similar survival rates but a higher incidence of locoregional recurrence than those who underwent lobar resection. The authors of a letter to the editor state that more subgroup analyses are needed to interpret the findings and advocate that lobectomy remains the standard treatment.
| Safety Outcomes | Lobar Resection | Sublobar Resection |
|---|---|---|
| Locoregional recurrence (%) | 3.4 | 6.8 |
| Operative mortality | Lower | No counterbalancing advantages |
| Risk of complications | Lower | No counterbalancing advantages |
| Quality of life | Higher | No counterbalancing advantages |
| Adverse events due to treatment for recurrent disease | Probable added risk | N/A |
| Postoperative pulmonary function | Greater deterioration | 2-percentage-point lesser deterioration |
Main points:
- The study found noninferiority of sublobar resection to lobar resection for the primary endpoint of disease-free survival, with a hazard ratio of 1.01 and a P value for noninferiority of 0.02.
- Results for overall survival were similar in both groups.
- Differences in the incidence of recurrence and other comparisons beyond the primary endpoint should be regarded as hypothesis-generating rather than hypothesis-testing.
- The authors of the letter to the editor advocate for more subgroup analyses on tumor location, resection margins, consolidation-to-tumor ratio, high-risk histologic subtypes, and intraoperative interlobar or lobar N1 nodal status to determine the most appropriate surgical strategy.
- The authors of the letter suggest that lobectomy remains the standard treatment for the majority of patients with NSCLC until more comprehensive analyses are available.
NEJM Group. (2023). Extent of Surgery for Stage IA Non–Small-Cell Lung Cancer. New England Journal of Medicine, 388(17), 1629-1630.