The Role of Surgery for Stage 0 Adenocarcinoma in Situ of the Lung: A National Analysis

Objectives: Overall survival (OS) of patients with stage 0 adenocarcinoma in situ (AIS) of the lung is not well characterized in the U.S. Specifically, there are a lack of data regarding the OS of patients with stage 0 AIS who do not receive treatment. We compared OS among stage 0 AIS patients who received surgery and those who received no treatment. Methods: OS of patients with stage 0 (TIS, N0, M0) AIS of the lung who received surgery versus no treatment from 2010-2018 in the National Cancer Data Base was evaluated using multivariable Cox proportional hazards modeling and propensity score-matched analysis. Predictors of surgery were evaluated using multivariable logistic regression. Survival outcomes based on surgical approach were evaluated in a propensity score-matched subgroup analysis. Results: Of the 897 patients who were diagnosed with stage 0 AIS, 716 (79.8%) underwent surgical resection. A propensity score-matched analysis of 134 patients who received no treatment and 134 patients who underwent surgery showed that the surgical group had a significantly improved OS at five-years 85.8% (95% CI: 74.2-92.4%) compared to the group who received no treatment 62.8% (95% CI: 50.1-72.7%) (log-rank, p <0.0001). Subgroup propensity score-matched analysis showed no significant differences in OS at five-years in the surgical group who underwent a wedge resection 90.8% (95% CI: 83.8-94.8) compared to a lobectomy 94.9% (95% CI: 89.9-97.4%) (log-rank, p=0.19). Conclusions: In this national analysis, stage 0 AIS patients who underwent surgery had significantly better OS when compared to patients who did not receive treatment.