Wedge resection as an alternative treatment for octogenarian and older patients with early-stage non–small-cell lung cancer

• Published in: Japanese journal of clinical oncology 2020-09, Vol.50 (9), p.1051-1057
• Main Authors: Mimae, Takahiro, Miyata, Yoshihiro, Tsutani, Yasuhiro, Imai, Kentaro, Ito, Hiroyuki, Nakayama, Haruhiko, Ikeda, Norihiko, Okada, Morihito
• Format: Article
• Language: English
• ISSN: 1465-3621; 1465-3621
• DOI: 10.1093/jjco/hyaa085

OBJECTIVEAnatomical resection with lymph node dissection is the standard treatment for early non-small cell lung cancer, whereas wedge resection is considered as a compromise. We aimed to determine whether wedge resection without lymph node dissection could be a treatment option for patients aged ≥80 years. METHODSWe assessed 669 patients with clinical stage IA non-small cell lung cancer, whole tumour sizes ≤2 cm and a consolidation to tumour ratio of >0.5 who underwent R0 resection at three institutions between 2010 and 2016. We selected 58 of them who were aged ≥80 years and analysed their clinicopathological findings and prognosis after surgical procedures over a median follow-up of 38 months. Propensity scores for surgical procedures were calculated using age, gender, smoking status and solid tumour size on computed tomography. RESULTSThree-year overall and recurrence-free survival rates after wedge resection and after segmentectomy + lobectomy for patients aged ≥80 years did not significantly differ (overall survival: 88.9% [95% confidence interval, 69.4-96.3%] vs. 75.5% [95% confidence interval, 51.5-88.8%], P = 0.95; recurrence-free survival: 85.2% [95% confidence interval: 65.2-94.2%] vs. 68.0% [95% confidence interval, 44.4-83.2], P = 0.57). Multivariable Cox regression analysis of overall survival with propensity scores revealed that surgical procedure was not an independent predictor of a poor prognosis (hazard ratio: 0.86 (0.28-2.6), P = 0.78) in patients aged ≥80 years. CONCLUSIONSWedge resection might be an alternative to lobectomy or segmentectomy with lymph node dissection for patients aged ≥80 years with early non-small cell lung cancer.