1969 - Wedge resection with omission of lymph node dissection as an optional treatment strategy in octogenarians or older with early stage non-small cell lung cancers

Background

In early stage non-small cell lung cancer (NSCLC), the anatomical resection with lymph node dissection is a standard procedure as a curative intent while wedge resection is considered as a passive treatment. However, optimal treatment strategy for elderly ( > = 80 y.o.) patients remains controversial. We attempted to disclose the role of wedge resection without lymph node dissection as a treatment option in octogenarians or older.

Methods

Among 671 patients with clinical stage IA NSCLC with whole tumor size is 2 cm or less and consolidation to tumor ratio is more than 0.5 underwent R0 resection in three institutions between 2010 and 2015, 55 octogenarians or older were investigated about clinicopathological findings and prognosis based on surgical procedures and lymph node dissection status.

Results

The median follow-up time was 35 months. The 3-year overall survival (OS) rate for octogenarians or older was 83.8% (95% confidential interval (CI): 69.7-91.7%). No significant differences for OS were detected among three surgical procedures (3-year OS rate: wedge resection: 88.5% (95%CI: 68.4-96.1%), segmentectomy: 83.3% (95%CI: 27.3-97.5%) , and lobectomy: 78.9% (95%CI: 53.0-91.6%), P = 0.72) or lymph node dissection status (3-year OS rate: ND0: 88.9% (95%CI: 69.4-96.3%) and ND1 or 2: 77.0% (95%CI: 50.8-90.4%), P = 0.95). The multivariable Cox regression analysis revealed that male gender (Hazard ratio (HR): 4.7 (1.1-20.2), P = 0.039) and larger solid tumor size (HR: 5.8 (1.1-29.9), P = 0.035) were independent poor prognostic factors whereas surgical procedure (wedge resection vs. segmentectomy or lobectomy) (HR: 0.50 (0.15-1.7), P = 0.27) was not. In another model, lymph node dissection status (ND0 vs. ND1 or 2) (HR: 0.51 (0.15-1.8), P = 0.28) was not found to be a prognostic factor.

Conclusions

In octogenarians or older with early stage NSCLC, wedge resection without lymph node dissection might be an alternative option to lobectomy or segmentectomy with lymph node dissection.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.