Outcomes with Sublobar Resection vs Lobectomy in Patients With cT1N0M0 Large-cell Neuroendocrine Cancer

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonary Medicine

Background:

• Large-cell neuroendocrine cancer (LCNEC) is a rare and aggressive tumor type.
• Patients with LCNEC often face a poor prognosis.
• Accurate pre-operative diagnosis of LCNEC can be challenging.

Purpose of the Study:

• To compare outcomes between sublobar resection and lobectomy for clinical T1N0M0 LCNEC.
• To evaluate the impact of surgical approach on overall survival and recurrence-free survival.
• To assess locoregional recurrence rates following different resection strategies.

Main Methods:

• Retrospective analysis of patients with clinical T1N0M0 LCNEC undergoing lobectomy or sublobar resection (segmentectomy/wedge resection).
• Comparison of outcomes using unmatched and propensity-matched cohorts.
• Evaluation of overall survival, recurrence-free survival, and locoregional recurrence rates.

Main Results:

• No significant difference in overall survival or recurrence-free survival between lobectomy and sublobar resection in both unmatched and matched cohorts.
• Sublobar resection was associated with a significantly higher rate of locoregional recurrence (44.1% vs 14.5%).
• Overall recurrence rates did not differ significantly between the two surgical approaches.

Conclusions:

• Sublobar resection may offer comparable survival to lobectomy for early-stage LCNEC.
• Sublobar resection might compromise long-term locoregional disease control in LCNEC.
• An individualized treatment strategy is recommended for LCNEC, particularly when diagnosed post-operatively after sublobar resection.