Sublobar Resection vs Lobectomy for High-Risk Stage I Non–Small Cell Lung Carcinoma
Menée à partir des données d'un essai randomisé multicentrique portant sur 697 patients atteints d'un cancer du poumon non à petites cellules de stade T1N0 (âge médian : 67,8 ans ; 57,4 % de femmes ; durée médiane de suivi : 7 ans), cette étude analyse les taux de survie et de récidive après une résection lobaire ou sous-lobaire en fonction de l'envahissement de la plèvre viscérale
The Cancer and Leukemia Group B (CALGB140503; also known as ALLIANCE) is a phase 3 trial that demonstrated that peripheral (outer third of lung) non–small cell lung carcinoma (NSCLC) with tumor size 2 cm or smaller and lymph node (LN) negative for metastasis, sublobar resection (defined as wedge resection or segmentectomy) compared to lobectomy was not inferior in disease-free survival (DFS) and overall survival (OS). The Japan Clinical Oncology Group (JCOG0802; also known as West Japan Oncology Group WJOG4607L study) is also a phase 3 trial that revealed that peripheral NSCLC with tumor size 2 cm or smaller with consolidation to tumor ratio more than 0.5 and LN negative for metastasis, segmentectomy (wedge resection was not allowed) compared to lobectomy was not inferior in relapse-free survival (RFS) and OS. Both trials are practice changing and challenged the prior standard of care of lobectomy for peripheral tumors 3 cm and smaller and LN negative for metastasis as established by the Lung Cancer Study Group.
JAMA Oncology , éditorial, 2023