Segmentectomy vs Lobectomy for Patients With 2- to 3-cm Non-Small Cell Lung Cancer

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonology

Background:

• Sublobar resection has shown noninferiority to lobectomy for smaller non-small cell lung cancer (NSCLC) T1a-bN0M0 tumors.
• The oncologic outcomes of segmentectomy versus lobectomy for node-negative T1c NSCLC (2-3 cm tumors) remain under investigation.

Purpose of the Study:

• To compare the overall survival of patients with T1c N0 M0 NSCLC who underwent either segmentectomy or lobectomy.
• To evaluate the efficacy of segmentectomy as a parenchymal-sparing alternative to lobectomy for larger early-stage NSCLC.

Main Methods:

• Analysis of the National Cancer Database (2010-2020) including patients with clinical or pathologic T1c N0 M0 NSCLC.
• Exclusion of patients with comorbidities to minimize selection bias.
• Comparison of overall survival using multivariable-adjusted Cox proportional hazards modeling and propensity score-matched analysis.

Main Results:

• No significant difference in overall survival was observed between segmentectomy and lobectomy for clinical T1c NSCLC in multivariable (aHR, 1.13; P = 0.23) or propensity score-matched analyses.
• Similarly, no survival difference was found for pathologic T1c NSCLC (aHR, 1.23; P = 0.11) in the adjusted analyses.
• Five-year survival rates were comparable between the two surgical groups for both clinical and pathologic T1c NSCLC.

Conclusions:

• Segmentectomy is a noninferior surgical option to lobectomy for patients with clinical or pathologic T1c NSCLC.
• These findings support the inclusion of patients with tumors up to 3 cm in future studies comparing lobectomy and sublobar resections.
• Parenchymal-sparing approaches like segmentectomy may be suitable for a broader range of early-stage NSCLC patients.