Should segmentectomy indications be extended to NSCLC smaller than 3 cm without lymph node involvement? A...

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Pulmonology

Background:

• Surgical resection is the standard treatment for stage IA non-small cell lung cancer (NSCLC).
• Comparing long-term outcomes of lobectomy and segmentectomy is crucial for optimizing treatment strategies.
• Identifying prognostic factors aids in personalized patient management for resected stage IA NSCLC.

Purpose of the Study:

• To compare the long-term oncologic outcomes of lobectomies versus segmentectomies in patients with stage IA NSCLC.
• To identify significant prognostic factors influencing survival and recurrence in resected stage IA NSCLC.

Main Methods:

• Retrospective monocentric study of 457 patients with stage cIA NSCLC (November 2015 - November 2021).
• Primary endpoint: event-free survival (EFS). Secondary endpoints: overall survival, recurrence-free survival, and short-term postoperative outcomes.
• Multivariate Cox regression analysis was used to identify prognostic factors.

Main Results:

• No significant difference in 5-year event-free survival between segmentectomy (75.0%) and lobectomy (83.0%) groups (p=0.054).
• Nodule type (solid vs. ground-glass/mixed) and vascular/lymphatic invasion were significant prognostic factors for EFS.
• Adjusted HR for nodule type: 2.07 (p=0.01); for vascular/lymphatic invasion: 2.25 (p=0.004).

Conclusions:

• Segmentectomy offers comparable oncologic outcomes to lobectomy for clinical stage IA NSCLC.
• Tumor characteristics (radiological appearance, histology) are critical for selecting surgical strategy.
• Further prospective multicenter studies are warranted to validate these findings.