Anatomic Lung Resection Is Associated With Improved Survival Compared With Wedge Resection for Stage IA (≤2 cm) NSCLC

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Generalizability of clinical trial data for early-stage non-small cell lung cancer (NSCLC) treatments is uncertain.
• Comparative effectiveness of lobectomy versus sublobar resection (segmentectomy, wedge resection) needs real-world validation.

Purpose of the Study:

• To evaluate the long-term survival outcomes of lobectomy, segmentectomy, and wedge resection for clinical stage IA NSCLC in a real-world patient population.
• To compare the effectiveness of different surgical resection types for early-stage NSCLC.

Main Methods:

• Analysis of adult patients with clinical stage IA NSCLC (≤2 cm) from 2012-2022 using the STS General Thoracic Surgery Database.
• Long-term vital status determined via linkage to National Death Index and CMS inpatient data.
• Stabilized inverse probability weighted Cox regression used to adjust for bias and compare survival outcomes (overall survival, lung cancer-specific survival).

Main Results:

• 32,340 patients analyzed: 19,778 lobectomies, 4,279 segmentectomies, 8,283 wedge resections.
• Lobectomy showed improved overall survival (OS) and lung cancer-specific survival (LCSS) compared to sublobar resection (HR [OS]=0.87, HR [LCSS]=0.84).
• Both lobectomy and segmentectomy demonstrated improved survival over wedge resection, with no significant difference between lobectomy and segmentectomy.

Conclusions:

• Lobectomy and segmentectomy are associated with superior OS and LCSS compared to wedge resection for stage IA NSCLC in clinical practice.
• Findings indicate a potential discrepancy between the efficacy observed in clinical trials and the effectiveness in real-world patient care.
• Real-world data supports the use of lobectomy or segmentectomy over wedge resection for early-stage NSCLC treatment.