T1/T2 non–small-cell lung cancer treated by lobectomy: Does tumor anatomic location matter?

doi:10.1016/j.jss.2012.05.022

Journal of Surgical Research

Volume 177, Issue 2, October 2012, Pages 185-190

https://doi.org/10.1016/j.jss.2012.05.022 Get rights and content

Abstract

Background

The effect of tumor location on long-term survival after lobectomy for stage I non–small-cell lung cancer is unclear. Current data are limited to a retrospective single-institution series. We sought to determine if tumor anatomic location (i.e., the particular lobe that was involved) confers a survival advantage based on population-based data.

Methods

Using the Surveillance, Epidemiology and End Results database (1988–2007), we identified patients who underwent lobectomy for pathologic T1/T2 adenocarcinoma or squamous cell carcinomas. Wedge resections, segmentectomies, and pneumonectomies were excluded. We evaluated the association between the particular lobe that was involved, lymph node (LN) yield, and survival using the Kaplan–Meier method. To adjust for potential confounders, we used a Cox proportional hazards regression model.

Results

We identified 13,650 patients who met our inclusion criteria. There were significant differences in unadjusted overall (P = 0.03) and cancer-specific survivals (P = 0.03) based on tumor location. However, after adjusting for patient factors, geographic location of treatment, and tumor characteristics, we found that tumor location was not associated with significant differences in survival. We found that male gender, black race, squamous cell histology, increasing grade, and age were independent negative predictors of survival. Higher LN yields were independently associated with improved survival. Although adjusted survival rates were not significantly different, there were significant differences (P < 0.0001) in LN yield based on tumor location; right middle lobe had the lowest yield (5.1 nodes), and left upper lobe had the highest yield (eight nodes).

Conclusions

LN counts are independent predictors of survival. Although it is associated with significant difference in LN yield, tumor location is not an independent predictor of survival. Age, race, gender, tumor size, histology, and grade appear to be more important prognostic factors. These data suggest that treatment of T1/T2 non–small-cell lung cancer should be dictated by the same oncologic principles, regardless of tumor location.

Introduction

In the surgical treatment of non–small-cell lung cancer (NSCLC), the impact of histology [1], [2], the extent of resection (i.e., lobectomy versus segmentectomy) [3], [4], [5], and the surgical approach (i.e., thoracoscopy versus thoracotomy) [6], [7], [8] on the outcome have been evaluated. The impact of the anatomic location of the tumor (e.g., which lobe is involved) on lymph node (LN) yield and survival for patients who undergo lobectomy for T1/T2N0M0 NSCLC, however, is unclear. Thus far, the available data in the literature are limited to a retrospective single-institution series [9].

We used a large, national, population-based data set to assess the impact of tumor location on LN yield and survival after lobectomy for stage I NSCLC. We hypothesized that tumor anatomic location affects LN yield but does not impact survival after lobectomy for T1/T2N0M0 NSCLC.

Section snippets

Methods

The Surveillance, Epidemiology, and End Results (SEER) database was found in 1973 by the National Cancer Institute (Bethesda, MD). Currently, the SEER data set includes data from 17 cancer registries, encompassing approximately 26% of the U.S. population. For this analysis, we used the November 2009 submission. This version contains data through December 31, 2007. For our analysis, we limited data to those collected from January 1, 1988 (the year SEER began collecting American Joint Committee

Results

Through our evaluation of the SEER data set, we identified 13,650 patients who met our inclusion criteria (Fig. 1). There were significant differences between patients based on tumor location (Table 1).

Discussion

Through our analysis of the SEER data set of patients who underwent a lobectomy for T1/T2 NSCLC, we identified several salient points. By unadjusted univariate analysis, there were significant differences in survival depending on which lobe of the lung was resected. However, after adjusting for patient factors, tumor characteristics, and geographical location of treatment, there were no significant differences in all-cause and cancer-specific mortalities based on tumor location.

Our results are

Conclusions

Using the National Cancer Institute population–based SEER data set, we found through multivariate analysis that the location of the primary tumor did not impact survival. The importance of a thorough LN evaluation was reflected by improved survival rates with higher LN yields. Our population-based data suggest that a patient's treatment planning or planning for potential of surgical resection should not be influenced by tumor location alone. The impact of parenchymal volume, perfusion, and

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Among 15.477 histologically proven cases of primary lung cancers of white men in the Surveillance, Epidemiology, and End Results (SEER) Study, 65% of the tumors originated in the upper lobes compared with 35% in the middle or the lower lobes [8]. However, two recent retrospective series have shown that primary tumor localization (i.e. upper vs. lower) did not influence survival in patients undergoing resection for early stage NSCLC [9,10]. Authors of these studies, therefore, concluded that treatment of these patients should be performed by the same oncological principles regardless of primary lobar tumor location.
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^☆: Presented at the 7th Annual Academic Surgical Congress held during February 14–16, 2012, Las Vegas, Nevada.

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Association for Academic SurgeryT1/T2 non–small-cell lung cancer treated by lobectomy: Does tumor anatomic location matter?☆

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Conclusions

J Thorac Cardiovasc Surg

Chest

Chest

Ann Thorac Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

Association for Academic Surgery
T1/T2 non–small-cell lung cancer treated by lobectomy: Does tumor anatomic location matter?☆