Sublobar resection is non-inferior to lobectomy in octogenarians and older with stage Ia non‑small cell lung cancer

For individuals aged 80 years and older with early-stage non-small cell lung cancer (NSCLC), prior research has indicated that surgical intervention accompanied by lymphadenectomy may offer superior long-term survival outcomes compared to radiotherapy; however, the selection of the appropriate surgical approach continues to be a subject of debate. So, our aim is to compare overall survival (OS) differences between two surgical modalities (lobectomy and sublobar resection) in patients aged 80 years and older with pathological stage Ia NSCLC according to the 8th edition of the tumor-node-metastasis (TNM) staging system.

Patients aged ≥80 years with pathological stage Ia (T1N0M0) NSCLC from 2004 to 2021 were identified using the Surveillance, Epidemiology, and End Results (SEER) database. Patients were assigned to either the lobectomy or sublobar resection group. Optimal cutoff values for lymph nodes examined (LNE) were determined using X-Tile software, and lymph node status was classified into low dissection (1 to 5 lymph nodes) and high dissection (6 or more lymph nodes) groups. Confounding factors were controlled through propensity score matching (PSM) analysis, and OS results were analyzed using the Kaplan-Meier method. Survival-related factors were identified using multivariate Cox regression analysis.

A total of 1,735 patients were identified, with 30.0% in the sublobar resection group and 70.0% in the lobectomy group. The OS of the lobectomy group was significantly higher than that of the sublobar resection group (P=0.02). The 1-, 3-, and 5-year OS rates were 90.79%, 71.38%, and 56.60% for the sublobar resection group, respectively, compared to 89.87%, 76.88%, and 60.94% for the lobectomy group. In multivariate Cox regression analysis, the high lymph node dissection group demonstrated better prognosis [hazard ratio (HR) =0.796; 95% confidence interval (CI): 0.690-0.919; P=0.002]. Younger age, female sex, adenocarcinoma histology, and smaller tumor sizes were independent prognostic factors for improved OS. After PSM, no significant difference in OS was observed between the two groups (P=0.28), with 1-, 3-, and 5-year OS rates of 87.69%, 76.43%, and 56.41% in the lobectomy group, and 90.21%, 70.54%, and 55.65% in the sublobar resection group. Multivariate Cox regression indicated that the high lymph node dissection group had a better prognosis (HR =0.765; 95% CI: 0.620-0.944; P=0.01). Additionally, younger age and female sex were identified as independent prognostic factors for better OS.

For patients aged 80 years and older diagnosed with stage Ia NSCLC, it is recommended that sublobar resection be performed in conjunction with the dissection of a minimum of six lymph nodes.