Surgical modality for stage IA non-small cell lung cancer among the elderly: analysis of the Surveillance, Epidemiology, and End Results database

• Published in: Journal of thoracic disease Vol. 12; no. 11; pp. 6731 - 6742
• Main Authors: Wang, Weixi, Sun, Yan, Li, Huiting, Bao, Minwei, Liu, Xiaogang, Jiang, Gening, Ye, Cong, Hu, Yu
• Format: Journal Article
• Language: English
• Published: China AME Publishing Company 01.11.2020
• Subjects: Original; wedge resection; lobectomy; segmentectomy; Elderly patients; non-small cell lung cancer (NSCLC)
• ISSN: 2072-1439; 2077-6624
• DOI: 10.21037/jtd-20-2221

The appropriate surgical modality for early-stage non-small cell lung cancer (NSCLC) among the elderly remains controversial; identifying appropriate modalities will be helpful in clinical practice. It's a cohort study and we explored the Surveillance, Epidemiology, and End Results (SEER) database for identifying patients aged ≥70 years with pathologic stage IA NSCLC. Three types of surgeries were compared (lobectomy, segmentectomy, and wedge resection) via survival and stratification analyses. Overall, 6,197 patients were enrolled. Among patients aged ≥76 years with tumor diameters ≤1 cm, significant differences in survival were noted for segmentectomy lobectomy [hazard ratio (HR) =0.294, P=0.007] and wedge resection lobectomy (HR =0.548, P=0.017) but not in those with tumors diameters >1 cm. Among patients aged 70-75 years with tumor diameters >1-2 cm, significant differences in survival were observed for segmentectomy lobectomy (HR =0.671, P=0.037) and segmentectomy wedge resection (HR =0.556, P=0.003) and for wedge resection lobectomy (HR =1.283, P=0.003) among those with tumor diameters >2-3 cm but not in those with tumor diameters ≤1 cm. Both age and tumor size should be considered when selecting the surgical modality. Lobectomy is not recommended for lesions ≤1 cm among patients aged ≥76 years. Segmentectomy was associated with superior prognosis for tumor diameters >1-2 cm and survival favored lobectomy rather than wedge resection for NSCLCs >2-3 cm among patients aged 70-75 years. Surgeons could rely on personal experience to determine the appropriate surgical modality for NSCLCs >1 cm among patients aged ≥76 years and NSCLCs ≤1 cm among patients aged 70-75 years.