Temporal Trends in the Utilization and Survival Outcomes of Lobar, Segmental, and Wedge Resection for Early-Stage NSCLC, 2004 to 2020
Introduction: Although lobectomy has long been the standard of surgical treatment for early-stage NSCLC, segmental and wedge resections have become another option often used over the past two decades. Methods: To examine the trends over time in the utilization, quality, and overall survival (OS) dif...
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Elsevier
2025-03-01
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| Series: | JTO Clinical and Research Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666364325000104 |
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| author | Eden Z. Deng, BS Xiaofei Wang, PhD Jianrong Zhang, MD, MPH Thomas E. Stinchcombe, MD Chi-Fu (Jeffrey) Yang, MD Nasser Altorki, MD |
| author_facet | Eden Z. Deng, BS Xiaofei Wang, PhD Jianrong Zhang, MD, MPH Thomas E. Stinchcombe, MD Chi-Fu (Jeffrey) Yang, MD Nasser Altorki, MD |
| author_sort | Eden Z. Deng, BS |
| collection | DOAJ |
| description | Introduction: Although lobectomy has long been the standard of surgical treatment for early-stage NSCLC, segmental and wedge resections have become another option often used over the past two decades. Methods: To examine the trends over time in the utilization, quality, and overall survival (OS) differences of lobectomy, segmentectomy, and wedge resection, we performed an observational, population-level study of 76,466 patients with T1 or T2 N0M0 NSCLC tumors 2 cm or less in size in the National Cancer Database, from 2004 to 2020. To compare the OS of the three treatments, we used inverse probability of treatment weighting to analyze a subgroup of cases with nodal examination and minimal comorbidity burden. Results: From 2004 to 2020, the use of lobectomy decreased from 75.2% to 67.6% of resections, wedge remained relatively stable (20.5%–22.8%), and segmentectomy increased from 4.3% to 9.7%. The likelihood of nodal assessments and negative margins has increased for all treatments. Younger patients, patients with low comorbidity burden, and patients with smaller tumors have become increasingly likely to receive segmental and wedge resections. Five-year OS of segmentectomy (80.6%, 95% confidence interval [CI]: 78.1%–83.2%) remained noninferior to lobectomy (83.6%, 95% CI: 83.1%–84.1%]), whereas wedge resection was inferior until 2016 to 2019 (five-y OS = 79.9%, 95% CI: 75.9%–83.8%). Conclusions: Sublobar resections, particularly segmentectomies, have increased in frequency and quality. The growing use of sublobar resections for younger and healthier patients highlights the need for additional clinical evidence demonstrating whether these trends do indeed lead to better outcomes. |
| format | Article |
| id | doaj-art-22a8bb24023d40b69d6af7bfd4adc93c |
| institution | Kabale University |
| issn | 2666-3643 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTO Clinical and Research Reports |
| spelling | doaj-art-22a8bb24023d40b69d6af7bfd4adc93c2025-02-08T05:01:18ZengElsevierJTO Clinical and Research Reports2666-36432025-03-0163100794Temporal Trends in the Utilization and Survival Outcomes of Lobar, Segmental, and Wedge Resection for Early-Stage NSCLC, 2004 to 2020Eden Z. Deng, BS0Xiaofei Wang, PhD1Jianrong Zhang, MD, MPH2Thomas E. Stinchcombe, MD3Chi-Fu (Jeffrey) Yang, MD4Nasser Altorki, MD5Department of Statistical Science, Duke University, Durham, North CarolinaDepartment of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, North Carolina; Corresponding author. Address for correspondence: Xiaofei Wang, PhD, Department of Biostatistics & Bioinformatics, Duke University Medical Center, 2424 Erwin Road Suite 1102, 11080 Hock Plaza, Duke Box 272, Durham, North Carolina 27705.Centre for Cancer Research & Department of General Practice and Primary Care, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia; Victorian Comprehensive Cancer Centre, Melbourne, Victoria, AustraliaDuke Cancer Institute, Duke University Medical Center, Durham, North CarolinaDepartment of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MassachusettsDepartment of Cardiothoracic Surgery, Weill Cornell Medicine, New York–Presbyterian Hospital, New York, New YorkIntroduction: Although lobectomy has long been the standard of surgical treatment for early-stage NSCLC, segmental and wedge resections have become another option often used over the past two decades. Methods: To examine the trends over time in the utilization, quality, and overall survival (OS) differences of lobectomy, segmentectomy, and wedge resection, we performed an observational, population-level study of 76,466 patients with T1 or T2 N0M0 NSCLC tumors 2 cm or less in size in the National Cancer Database, from 2004 to 2020. To compare the OS of the three treatments, we used inverse probability of treatment weighting to analyze a subgroup of cases with nodal examination and minimal comorbidity burden. Results: From 2004 to 2020, the use of lobectomy decreased from 75.2% to 67.6% of resections, wedge remained relatively stable (20.5%–22.8%), and segmentectomy increased from 4.3% to 9.7%. The likelihood of nodal assessments and negative margins has increased for all treatments. Younger patients, patients with low comorbidity burden, and patients with smaller tumors have become increasingly likely to receive segmental and wedge resections. Five-year OS of segmentectomy (80.6%, 95% confidence interval [CI]: 78.1%–83.2%) remained noninferior to lobectomy (83.6%, 95% CI: 83.1%–84.1%]), whereas wedge resection was inferior until 2016 to 2019 (five-y OS = 79.9%, 95% CI: 75.9%–83.8%). Conclusions: Sublobar resections, particularly segmentectomies, have increased in frequency and quality. The growing use of sublobar resections for younger and healthier patients highlights the need for additional clinical evidence demonstrating whether these trends do indeed lead to better outcomes.http://www.sciencedirect.com/science/article/pii/S2666364325000104Sublobar resectionSegmentectomyWedge resectionTemporal trendsNational Cancer DatabaseLung neoplasms |
| spellingShingle | Eden Z. Deng, BS Xiaofei Wang, PhD Jianrong Zhang, MD, MPH Thomas E. Stinchcombe, MD Chi-Fu (Jeffrey) Yang, MD Nasser Altorki, MD Temporal Trends in the Utilization and Survival Outcomes of Lobar, Segmental, and Wedge Resection for Early-Stage NSCLC, 2004 to 2020 JTO Clinical and Research Reports Sublobar resection Segmentectomy Wedge resection Temporal trends National Cancer Database Lung neoplasms |
| title | Temporal Trends in the Utilization and Survival Outcomes of Lobar, Segmental, and Wedge Resection for Early-Stage NSCLC, 2004 to 2020 |
| title_full | Temporal Trends in the Utilization and Survival Outcomes of Lobar, Segmental, and Wedge Resection for Early-Stage NSCLC, 2004 to 2020 |
| title_fullStr | Temporal Trends in the Utilization and Survival Outcomes of Lobar, Segmental, and Wedge Resection for Early-Stage NSCLC, 2004 to 2020 |
| title_full_unstemmed | Temporal Trends in the Utilization and Survival Outcomes of Lobar, Segmental, and Wedge Resection for Early-Stage NSCLC, 2004 to 2020 |
| title_short | Temporal Trends in the Utilization and Survival Outcomes of Lobar, Segmental, and Wedge Resection for Early-Stage NSCLC, 2004 to 2020 |
| title_sort | temporal trends in the utilization and survival outcomes of lobar segmental and wedge resection for early stage nsclc 2004 to 2020 |
| topic | Sublobar resection Segmentectomy Wedge resection Temporal trends National Cancer Database Lung neoplasms |
| url | http://www.sciencedirect.com/science/article/pii/S2666364325000104 |
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