Bronchitis vs. Pneumonia — Which Is It?
Real-World Practice Upholds Lobectomy For Early-Stage Lung Cancer
LOS ANGELES -- Surgeries to remove small tumors in stage IA non-small cell lung cancer (NSCLC) were associated with varying odds of long-term survival depending on the amount of lung removed, based on real-world data collected from across the country.
In routine practice, unadjusted 10-year overall survival (OS) for lobectomy reached 44.8%, while for segmentectomy it was 44.2%, and for wedge resection 41.4%, according to Christopher Seder, MD, of Rush University Medical Center in Chicago, at the annual meeting of the Society of Thoracic Surgeons (STS).
Lobectomy was associated with a significantly lower risk of all-cause mortality relative to sublobar resections in general (HR 0.87, 95% CI 0.83-0.92), though on closer inspection, this was really an advantage over wedge resections (HR 0.84, 95% CI 0.80-0.88) but not segmentectomy (HR 0.96, 95% CI 0.88-1.03). Segmentectomy was associated with fewer deaths than wedge resection (HR 0.88, 95% CI 0.81-0.95), Seder's group reported.
"This research is a significant step forward in understanding the long-term implications of surgical choices for lung cancer patients. Using real-world data to complement [randomized controlled trial] findings offers surgeons additional context for tailoring treatment strategies," Seder said in a press release.
The study was based on the STS General Thoracic Surgery Database. Findings were similar for lung cancer-specific survival, according to the authors.
For early-stage NSCLC, lobar resection has been the gold standard since 1995 with publication of the LCSG trial. Given that many people do not meet criteria or cannot tolerate the procedure, however, there are alternatives in the less invasive sublobar resection surgeries, namely wedge resection or segmentectomy.
Some research goes as far as to suggest that sublobar resections are the new standard of care for selected patients.
In 2022, the CALGB randomized trial showed that sublobar resection performed as well as lobectomy for NSCLC tumors ≤2 cm. Around the same time, the JCOG 0802 trial reported that, in patients with NSCLC ≤2 cm, segmentectomy was not inferior to lobectomy in terms of the primary endpoint of OS.
Seder pointed out the questionable generalizability of these studies. JCOG included 44% never-smokers and mostly adenocarcinoma, and the median forced expiratory volume in 1 second was over 2L. CALGB was characterized by strict inclusion criteria, upfront node dissection, and confirmation of N0 status by means of frozen-section examination.
Thus, his group opted to perform a study using real-world data.
"I want to stress that these data should not be seen as contradictory to the CALGB trial or the JCOG trial, but instead complementary," Seder told the audience. He pointed out that in the real world, 20% of wedge resections don't have nodal dissections and there is overall less station sampling.
"The take-home message here is really that if you expect trial results, the very strict selection criteria that are used on-trial need to be applied in the intraoperative protocol of sending your nodes first and so on and so forth," he said.
The ostensibly inferior results of the wedge resection group also prompted session discussant John Mitchell, MD, of the University of Colorado School of Medicine in Aurora, to ask what the data might suggest about other treatments such as stereotactic body radiotherapy (SBRT) for NSCLC.
Seder responded with the advantages of surgery, citing the surgeons' track records of safety and lymph node dissections that can help pathology reporting. "However, is SBRT worse than a wedge [resection] with 1 mm margin and one node taken? I can't say for sure."
He urged that thoracic oncology teams put more patients on trials trying to answer the question of whether the alternative forms of treatment are better than lung surgery, especially for high-risk patients.
The STS database used for the present study covered 346 participating institutions, with data spanning the years 2012 to 2022. Included were 32,340 adults undergoing lung resection surgery for clinical stage IA NSCLC 2 cm or smaller, excluding high-risk patients.
In the registry cohort, 61.2% underwent lobectomy, 13.2% segmentectomy, and 25.6% wedge resection.
To determine the long-term vital status of these patients, the investigators linked the STS database to national death and hospitalization records from the CDC and CMS.
In sensitivity analyses excluding pathologic-upstaged cases, Seder and colleagues found that lobectomies were associated with improved long-term survival versus sublobar resection, wedge resection, and segmentectomy.
Seder acknowledged the study's potential for residual confounding. "There are multiple factors that may affect long-term survival that are not collected and cannot be accounted for," he cautioned.
Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow
Disclosures
Seder had no disclosures.
Mitchell reported serving on an advisory board and consulting for DaVinci Intuitive Surgical.
Primary Source
Society of Thoracic Surgeons
Source Reference: Seder CW "Anatomic lung resection is associated with improved survival compared with wedge resection for stage IA non-small cell lung cancer" STS 2025.
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The Early Lung Cancer Warning Symptom You Can Feel In Your Fingers And Toes
You may not notice any obvious signs of lung cancer in its early stages, but they may show up in some unexpected parts of your body as it progresses Feeling pins and needles may be a sign of something serious, experts say (Image: E+/Getty Images)
Lung cancer, one of the four most common types of cancer in the UK, sees over 49,000 new cases each year, according to Cancer Research UK.
This disease is triggered by an uncontrolled growth of abnormal cells in one or both lungs, which are crucial for oxygen intake and carbon dioxide expulsion.
Lung cancer in its early stages may not exhibit any noticeable symptoms. However, as the disease progresses, symptoms can appear throughout the body.
In rare instances, people might experience pins and needles or numbness in their fingers or toes if lung cancer cells release hormones into the bloodstream.
"These hormones can cause symptoms that don't seem related to the lung cancer. Doctors call them paraneoplastic syndrome," said Cancer Research UK.
Lung cancer symptomsThe primary symptoms of lung cancer include:
The main symptoms of lung cancer are:
Image:
Getty Images/iStockphoto)Should any symptoms reminiscent of lung cancer arise, such as breathlessness or a continuous cough, the NHS recommends consulting a GP, reports the Express.
What will happen at a GP appointment?The NHS website explained: "The GP will ask about your general health and your symptoms. They may examine you and ask you to breathe into a device called a spirometer, which measures how much air you breathe in and out. You may be asked to have a blood test to rule out some of the possible causes of your symptoms, such as a chest infection."
A chest X-ray is often the first step in spotting lung cancer, as tumours typically show up as a white-grey area on the image.
Am I at risk of lung cancer?It varies from person to person, but puffing on cigarettes is the top culprit. Cancer Research UK found that 60% of lung cancer cases are tobacco-related, including passive smoking.
The charity urges smokers to kick the habit sooner rather than later, warning that the risk of lung cancer "increases more the longer you smoke and the more you smoke".
What are the other causes of lung cancer?Air pollution might not be as well-known, but it's still a significant hazard, responsible for 8% of UK cases.
The NHS also flags exposure to certain workplace chemicals and substances as potential dangers. These include:
Moreover, research has highlighted that long-term contact with diesel exhaust, such as nitrogen oxide gases, could up your chances of getting lung cancer.
Dodging certain lifestyle choices can help lower your risk, but studies suggest that embracing positive habits could further reduce the likelihood of developing the condition.
Research indicates that a diet low in fat and high in fibre, including at least five daily servings of fresh fruit and vegetables along with ample wholegrains, can decrease your risk of lung cancer, as well as other forms of cancer and heart disease.
There's also persuasive evidence suggesting that regular physical activity can lower the risk of developing lung cancer and other types of cancer.
Small Cell Lung Cancer: Facts About The Disease
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