SUBLOBAR RESECTIONS VS. LOBECTOMY FOR STAGE I NON-SMALL CELL LUNG CANCER (NSCLC): AN APPROPRIATE CHOICE IN HIGH-RISK ELDERLY PATIENTS?

Objectives: Even though lobectomy remains the standard therapy for nonsmall- cell lung cancer (NSCLC), sublobar resections are commonly used for elderly patients with serious comorbidities and poor cardiopulmonary reserve. We investigated if sublobar resections, performed as a compromise solution, afforded recurrence and survival rates equivalent to lobectomy in high-risk elderly patients, a still controversial issue due to paucity of literature data. Methods: This is a retrospective multicentre study including consecutive patients aged >75 years operated for clinical stage I NSCLC between January 2007 and December 2013. Clinico-pathological data, postoperative morbidity(OS), cancer specific survival (CSS) and disease-free survival (DFS) were assessed. Kaplan-Meyer method, log-rank test, Cox regression analysis and propensity score matching were used in the statistical analysis. Results: Two hundred and thirty-nine patients (median age: 78 years) were enrolled. Lobectomies were performed in 149 (62.3%) patients, sublobar resections in 90 (39 segmentectomies, 51 wedge resections). Sublobar group patients had a lower ppoFEV1% (50 ± 20 vs 69 ± 18; P < 0.0001) and ppoDLCO% (56 ± 10 vs 71 ± 14; P < 0.0001) and a higher Charlson comorbidity index (8.5 ± 0.9 vs 6.4 ± 1.1; P < 0.0001) while lobectomy patients had a higher incidence of unexpected pN2 disease (9% vs 2%; P = 0.3) probably due to different attitudes regarding lymphadenectomy. There was no significant difference in postoperative morbidity (P = 0.5), mortality (P = 0.9), OS (P = 0.1), CSS (P = 0.2), and DFS (P = 0.2) between the two groups of patients. Even after adjusting for 1:1 propensity-matching score and matched pair analysis, results were unchanged. Tumour size (P = 0.01) and pN2 disease (P = 0.003) were independent negative prognostic factors. Conclusions: Our data showed that high-risk, elderly patients may benefit from sublobar resections which provide similar postoperative morbidity and mortality rates and equivalent long-term survival, compared to lobectomy. Future prospective studies should corroborate such results.