番茄社区

Sublobar resection was on par with lobectomy for non-small cell lung cancer tumors with a diameter of 2 cm or less, according to results presented at the recent World Conference on Lung Cancer (WCLC).

In this exclusive 番茄社区 video, Nicholas Rohs, MD, of the Icahn School of Medicine at Mount Sinai in New York City, discusses the results and what it means for patients.

Following is a transcript of his remarks:

So Dr. [Nasser] Altorki and his colleagues put together a good study here. This was approximately 350 patients randomized to each arm. And these patients were early-stage clinical IA non-small cell lung cancer patients. And this was an operative study looking at lobar versus sublobar resection. And they were intraoperatively randomized to either lobar or sublobar resection, either a segmentectomy or wedge resection, depending on the surgeon's choice. And this was the 7-year median follow-up for these patients. So this was good long-term data.

And this trial had a primary endpoint of disease-free survival in the sublobar group. And they were looking for noninferiority and that's what they found. They found that sublobar resections were noninferior to a lobar resection with the disease-free survival comparing 63.3 months versus 64.1 months, with a hazard ratio right on the button of 1.01. So this really did prove that as far as their primary endpoint, these two groups were comparable.

They also looked at a key secondary endpoint of overall survival. And again, this looked very comparable, 5-year overall survival of 80.3% versus 78.9%, with again a hazard ratio right around 1, at 0.95. So really again, confirming both for disease-free survival, as well as overall survival that these sublobar resections are pretty much equivalent or noninferior to a lobar resection.

Other really key takeaways from this trial was that the demographics of these patients didn't seem to matter much. The sex, the performance status, didn't seem to affect outcomes, as well as histology or size of tumor -- didn't seem to matter. Of course, these were all smaller tumors. These were 2 cm or less, but the exact size of the tumor didn't seem to reflect on outcomes.

And one of the key questions that people were discussing at this meeting was, the wedge resections were a pretty good chunk of patients, and is this really comparable to a segmentectomy? And it seems like if you have a good margin that a wedge resection is a really reasonable choice and probably noninferior to doing a whole lobar resection.

And what does this mean for us and for our patients? Well, I think that this is something that we've been hoping for for a long time. Lobar resections have been the standard of care for really decades. And while a lot of common practices has been having sublobar resections, it's really nice to have the data to support this. I think this is good for our patients. It's leaving more cardiopulmonary reserve for them. Hopefully they're gonna have better quality of life, and [it] will hopefully leave more future therapeutic options.

So for a patient who has a local resection, if they happen to have a recurrence, there may be more room for another local resection or another definitive therapy like radiation. And this trial also showed that local recurrence rates were essentially the same in both arms, around 8% to 10%. And I think that as the world of lung cancer screening is amping up, and as long as we're catching earlier tumors, this is a really meaningful piece of data that I think is really the new standard of care for resectable early-stage peripheral, non-small cell lung cancer tumors.

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