Lobar or Sublobar Resection for Peripheral Stage IA Non–Small-Cell Lung Cancer

作者：Nasser Khaled Altorki, Xiaofei Wang, David Kozono, Colleen Watt, Rodney Landrenau, Dennis A. Wigle, Jeffrey L. Port, David Randolph Jones, Massimo Conti, Ahmad S. Ashrafi, Moïshe Liberman, Kazuhiro Yasufuku, Stephen C. Yang, John D. Mitchell, Harvey Ira Pass, Robert J. Keenan, THOMAS L BAUER, Daniel Miller, Leslie J. Kohman, Thomas E. Stinchcombe, Everett E. Vokes · 发表于：New England Journal of Medicine · 年份：2023 · DOI：10.1056/nejmoa2212083 · 被引用次数：1104 · 研究领域：Lung Cancer Diagnosis and Treatment、Lung Cancer Treatments and Mutations、Hepatocellular Carcinoma Treatment and Prognosis

BACKGROUND: The increased detection of small-sized peripheral non-small-cell lung cancer (NSCLC) has renewed interest in sublobar resection in lieu of lobectomy. METHODS: We conducted a multicenter, noninferiority, phase 3 trial in which patients with NSCLC clinically staged as T1aN0 (tumor size, ≤2 cm) were randomly assigned to undergo sublobar resection or lobar resection after intraoperative confirmation of node-negative disease. The primary end point was disease-free survival, defined as the time between randomization and disease recurrence or death from any cause. Secondary end points were overall survival, locoregional and systemic recurrence, and pulmonary functions. RESULTS: From June 2007 through March 2017, a total of 697 patients were assigned to undergo sublobar resection (340 patients) or lobar resection (357 patients). After a median follow-up of 7 years, sublobar resection was noninferior to lobar resection for disease-free survival (hazard ratio for disease recurrence or death, 1.01; 90% confidence interval [CI], 0.83 to 1.24). In addition, overall survival after sublobar resection was similar to that after lobar resection (hazard ratio for death, 0.95; 95% CI, 0.72 to 1.26). The 5-year disease-free survival was 63.6% (95% CI, 57.9 to 68.8) after sublobar resection and 64.1% (95% CI, 58.5 to 69.0) after lobar resection. The 5-year overall survival was 80.3% (95% CI, 75.5 to 84.3) after sublobar resection and 78.9% (95% CI, 74.1 to 82.9) after lobar resection. ...