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CALGB 140503 showed that removing only part of a lobe is as good as removing the whole lobe for small peripheral lung cancers, so screen-detected tumours can be cured with less lung taken out.
CALGB 140503 randomised 697 patients with a peripheral non-small-cell lung cancer of 2 cm or less and nodes confirmed negative at surgery to sublobar resection (segmentectomy or wedge) or lobectomy. Lobectomy had been the standard since the 1995 Lung Cancer Study Group trial, which found more recurrences after limited resection, but that trial predated CT screening and modern staging.
Five-year disease-free survival was 63.6 percent after sublobar resection and 64.1 percent after lobectomy (hazard ratio 1.01, non-inferior), and five-year overall survival was 80.3 percent and 78.9 percent. Locoregional recurrence was no higher after sublobar resection, and lung function at six months was slightly better preserved.
With the Japanese JCOG0802 trial, which found segmentectomy at least as good as lobectomy for the same tumours, the trial changed guidelines: sublobar resection is now an accepted standard for small peripheral node-negative tumours, which are the ones low-dose CT screening finds.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
697 enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Disease-free survival at 5 yearsprimary | Sublobar resection | 340 | 63.6% | 1.01 | - | link |
| Lobectomy | 357 | 64.1% | ||||
| Overall survival at 5 years | Sublobar resection | 340 | 80.3% | - | - | link |
| Lobectomy | 357 | 78.9% |
Shares Segmentectomy (sublobar resection), Minimally invasive surgery (laparoscopic, robotic, VATS), Lobectomy, Lung cancer (all types).
Shares Lobectomy, Resectable stage I to III non-small-cell lung cancer, Lung cancer (all types), Non-small-cell lung cancer.
Shares STARS and ROSEL pooled analysis, Resectable stage I to III non-small-cell lung cancer, Lung cancer (all types), Non-small-cell lung cancer.
Shares Lobectomy, Resectable stage I to III non-small-cell lung cancer, Lung cancer (all types), Non-small-cell lung cancer.
Shares Lobectomy, Resectable stage I to III non-small-cell lung cancer, Lung cancer (all types), Non-small-cell lung cancer.
Shares Low-dose CT lung screening, Resectable stage I to III non-small-cell lung cancer, Lung cancer (all types), Non-small-cell lung cancer.
Shares Low-dose CT lung screening, Lung cancer (all types), Non-small-cell lung cancer.
Shares Lobectomy, Resectable stage I to III non-small-cell lung cancer, Non-small-cell lung cancer.