87. Lobectomy Is Superior to Sublobar Resection for Stage I Large Cell Neuroendocrine Carcinoma of the Lung
Adnan M. Al-Ayoubi, Evgeny V. Arshava, John Keech, *Kalpaj R. Parekh
University of Iowa Hospitals and Clinics, Iowa City, IA
Invited Discussant: *M. Blair Marshall
Objective: There is an increasing trend towards parenchymal sparing sublobar resections for early stage lung cancer. In select patients groups, multiple studies have shown comparable survival to lobectomy. However, the impact of extent of resection for less common pathologies such as large cell neuroendocrine carcinoma (LCNEC) of the lung on survival remains unknown. Here we use a national database to compare the survival outcomes following lobectomy vs. sublobar resection for stage I LCNEC.
Methods: Using the Surveillance, Epidemiology and End Results (SEER) database, we identified all cases of surgically resected stage I LCNEC between 1988 and 2012. Cancer staging was recalculated according to AJCC 8thedition. The following variables (age, gender, race, laterality, stage, grade and surgical procedure) were examined. Survival and predictors of survival were assessed using Kaplan-Meier and Multivariate Cox proportional hazards model.
Results: A total of 407 cases were identified. Most patients (N = 316, 77.6%) underwent lobectomy. On univariate analysis, sublobar resection was significantly associated with advanced age (p < 0.001) and earlier stage (IA vs. IB, p = 0.01). For all stage I LCNEC, 1-, 3- and 5-year overall survival following lobectomy were 89.5%, 72.7% and 63% compared to 84%, 56% and 41% for sublobar resection, respectively (p = 0.004). When stratified by stage: stage IA (Lobectomy: 92%, 79.2% and 66% vs. Sublobar: 87%, 54.1% and 45%, respectively; p = 0.009) and stage IB (Lobectomy: 86.5%, 63.4% and 59.2% vs. Sublobar: 76%, 59.4% and 33.5%, respectively; p = 0.079) showed improved 1-, 3- and 5-year overall survival in patients who underwent lobectomy. When stratified by age, similar trends were observed for patients younger than 70 years old (lobectomy: 92%, 78% and 68% vs. sublobar: 89%, 58% and 42.5%, respectively; p = 0.027) but not for patients older than 70 (p = 0.299). On multivariate Cox-proportional hazards analysis, advanced age (HR 1.051, p < 0.001), stage IB (HR 1.48, p = 0.023) and sublobar resection (HR 1.64, p = 0.008) were significantly associated with increased risks of death.
Conclusions: In this population-based study, lobectomy remains the gold standard procedure for resection of stage I LCNEC and should be offered to patients when technically and medically feasible. Sublobar resection may be considered as an alternative option for patients older than 70 years old with similar survival outcomes.
Cox Proportional Hazards Model
Age at diagnosis