Evidence map›Paper›PMID 34590002›Full record

ArticleJTO clinical and research reports2021

The Survival Advantage of Lobectomy over Wedge Resection Lessens as Health-Related Life Expectancy Decreases.

Michelle C Salazar, Maureen E Canavan, Samantha L Walters, Sitaram Chilakamarry, Theresa Ermer, Justin D Blasberg, James B Yu, Cary P Gross, Daniel J Boffa

Open access · goldAbstract read
In one paragraph

Article in JTO clinical and research reports, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
0.9field-weighted citation impact, top 26% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 8 citations in OpenAlex.

  1. Review
  2. Observational
  3. Article
  4. Article
  5. Article
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 4 institutions in 2 countries.

Michelle C SalazarDepartment of Surgery, Yale University School of Medicine, New Haven, Connecticut.
Maureen E CanavanCancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
Samantha L WaltersSection of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
Sitaram ChilakamarryDivision of Colon and Rectal Surgery, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas.
Theresa ErmerFaculty of Medicine, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
Justin D BlasbergSection of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
James B YuDepartment of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut.
Cary P GrossNational Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut.
Daniel J BoffaSection of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
Yale University · USFriedrich-Alexander-Universität Erlangen-Nürnberg · DEThe University of Texas Southwestern Medical Center · USYale Cancer Center · US

Funding

NRSA Training CoreTL1TR001864 · NCATS · YALE UNIVERSITY · PI CANTLEY, LLOYD G, EDELMAN, E. JENNIFER · 2016 to 2025
$9.9M
NCATS NIH HHS TL1 TR001864
6 · The paper itself

Abstract

introductionPatients with early-stage NSCLC typically must choose between a surgery with superior local control (lobectomy) or one that preserves lung parenchyma (wedge). Recognizing that many patients with cancer have competing mortality risks unrelated to cancer, we investigated whether an established model of predicting life expectancy could be used to identify patients with stage I NSCLC for whom survival after wedge is not different from lobectomy.

methodsA retrospective cohort study using the National Cancer Institute's Surveillance Epidemiology and End Results-Medicare was performed to evaluate survival among treatment-naive patients, diagnosed 2005-2015, who underwent lobectomy or wedge for stage I (≤2 cm tumors) NSCLC. Comorbidity-related life expectancy (CR-LE) was estimated using a standard life-table approach based on comorbid conditions, sex, and age. Cox models and perioperative complications were stratified by 5-year CR-LE.

resultsA total of 4560 patients (median age 74, interquartile range 70-78) were identified. CR-LE was greater than or equal to 5 years for 4016 patients (wedge = 23%). CR-LE was less than 5 years for 544 patients (wedge = 41%). Among patients with CR-LE greater than or equal to 5, wedge resection was associated with higher risk of mortality than lobectomy (hazard ratio: 1.68, 95% confidence interval: 1.52-1.86,

conclusionThe survival advantage of lobectomy over wedge for stage I NSCLC seems to dissipate among patients with shorter life expectancy owing to age and comorbidities. Wedge resection may be a reasonable option for patients at high risk of dying from non-cancer-related causes.

Indexed as

LobectomyMortalityNon–small cell lung cancerStage IWedge

Identifiers

PMID34590002
PMCPMC8474228
OpenAlexW3123989089

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.