Lobectomy vs Segmentectomy in Stage I Non-Small Cell Lung Cancer With Lymphatic Vascular Invasion

Non-small cell lung cancer (NSCLC) constitutes 80% of new lung cancers and causes significant morbidity and mortality. Surgical interventions include lobectomy and segmentectomy. Lymphovascular invasion (LVI) correlates with reduced survival and increased recurrence; however, treatment recommendations are lacking. The aim of this study was to analyze survival and clinical characteristics of segmentectomy vs lobectomy in patients with stage I NSCLC with LVI.

This retrospective cohort study, using the National Cancer Database from 2004 to 2020, identified patients with a diagnosis of NSCLC. Patients were propensity score matched by age, race, tumor size, and sex, divided into lobectomy and segmental resection groups. Statistical methods involved χ², analysis of variance, Kaplan-Meier survival analysis, multinomial logistic regression, and the Cox proportional hazards model. Data were analyzed using SPSS software version 27.0 (IBM Corp), with a significance threshold of P <.05.

Of 8028 patients meeting inclusion criteria, 7612 (94.8%) underwent lobectomy and 416 (5.2%) underwent segmentectomy. After propensity score matching, there remained no significant differences in median survival between the segmentectomy group and The lobectomy group (75.2% [95% CI, 64.1%-86.3%] vs 76.1.8% [95% CI, 66.1%-86.0%], respectively; P = .922) Multivariate analysis of segmentectomy vs lobectomy showed no difference in hazard between the groups (Cox proportional model hazard ratio, 1.01; 95% CI, 0.837-1.22; P = .922) or odds of death (unadjusted logistic regression, .826; 95% CI, 0.300-0.421; P = .178).

The main finding of this large, retrospective cohort study is that there was no significant difference in overall disease-free survival between patients who underwent segmental resection and patients who underwent lobectomy. After 1:1 propensity matching, there remained no significant difference between the 2 groups.