Association for Academic SurgeryT1/T2 non–small-cell lung cancer treated by lobectomy: Does tumor anatomic location matter?☆
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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Presented at the 7th Annual Academic Surgical Congress held during February 14–16, 2012, Las Vegas, Nevada.