Background: The appropriate use of sublobar resection versus lobectomy for stage I non-small cell lung cancer continues to be debated. A long-term analysis of the outcomes of these resections for stage I non-small cell lung cancer in a high-volume tertiary referral university hospital center was performed.
Methods: The outcomes of all stage I non-small cell lung cancer patients (n = 784) undergoing resection were analyzed from our lung cancer registry from 1990 to 2003. Lobectomy was the standard of care for patients with adequate cardiopulmonary reserve. Sublobar resection was reserved for patients with cardiopulmonary impairment prohibiting lobectomy. Predictors of overall survival and disease-free survival were evaluated. Statistical analyses included Kaplan-Meier estimates of survival, log-rank tests of survival differences, and multivariate Cox proportional hazards models.
Results: Lobectomy was used for 577 patients and sublobar resection for 207 patients. The median age was 70 years (range, 31 to 107 years). The median follow-up of patients remaining alive was 31 months. Compared with lobectomy, sublobar resection had no significant impact on disease-free survival, with a hazard ratio of 1.20 (95% confidence interval, 0.90 to 1.61; p = 0.24). Sublobar resection had a statistically significant association with overall survival when compared with lobectomy, with an increased hazard ratio of 1.39 (95% confidence interval, 1.11 to 1.75; p = 0.004). Twenty-eight percent of lobectomy patients experienced disease recurrence in that time compared with 29% of the sublobar patients. Seventy-two percent of the recurrences in the lobectomy cohort were distant metastasis versus 52% of the sublobar group recurrences (p = 0.0204).
Conclusions: Although sublobar resection is thought to be associated with increased incidence of local recurrence when compared with lobectomy, we found no difference in disease-free survival between the two types of resection for stage IA patients but slightly worse disease-free survival for stage IB.