CALGB 140503 (Alliance)
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.
Overview
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.
- 63.6 vs 64.1 out of 100 alive without the cancer coming back at 5 years with Sublobar resection compared with Lobectomy; 0.5 fewer per 100.
- On this measure the first group did worse, not better.
- Put another way, the treated group had about 1 percent higher chance of the event at any given time (hazard ratio 1.01).
- This is a surrogate endpoint: it measures the cancer being controlled or absent on scans and tests, which often, but not always, translates into living longer.
- 80.3 vs 78.9 out of 100 alive at 5 years with Sublobar resection compared with Lobectomy; 1.4 more per 100.
- Roughly one extra person helped for every 71 treated. That is a rough figure taken from the two percentages, not a guarantee for any one person.
- Overall survival counts deaths from any cause, so it is the most direct measure of whether a treatment helps people live longer.
- These results apply to the people the trial enrolled: Peripheral clinical stage IA non-small-cell lung cancer 2 cm or smaller with negative hilar and mediastinal nodes: sublobar resection (wedge or segmentectomy) versus lobectomy. People in a different situation may not see the same effect.
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 participants 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% |
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