Lobectomy versus sub-lobar resection for special type non-small cell lung cancer ≤2 cm

Recent randomized trials have shown no significant difference in survival outcomes between lobectomy and sub-lobar resection for non-small cell lung cancer (NSCLC) ≤2 cm. However, these studies predominantly included common subtypes, such as adenocarcinoma and squamous cell carcinoma, with limited data on special type NSCLC (ST-NSCLC). This study aimed to address this gap by comparing overall survival (OS) outcomes between lobectomy and sub-lobar resection in patients with ST-NSCLC ≤2 cm.

We analyzed Surveillance, Epidemiology, and End Results (SEER) database data (2000-2021) for clinical T1a-bN0M0 ST-NSCLC, including large cell carcinoma (LCC), large cell neuroendocrine carcinoma (LCNEC), adenosquamous carcinoma (ASC), malignant carcinoid (MC), and sarcomatoid carcinoma (SC). Patients undergoing lobectomy or sub-lobar resection were propensity score-matched to control baseline differences. OS was assessed using Kaplan-Meier methods and log-rank tests.

Of 6,517 patients (4,019 lobectomy, 2,498 sub-lobar resection), post-propensity score matching analysis showed lobectomy was associated with significantly better OS in LCC, LCNEC, ASC, and SC compared to sub-lobar resection. For MC, no OS difference was observed between approaches. In MC subgroup analysis, lobectomy was linked to longer OS in patients aged ≥60 years, white patients, and those without radiation or chemotherapy.

In early-stage ST-NSCLC ≤2 cm, lobectomy is associated with better survival outcomes than sub-lobar resection for LCC, LCNEC, ASC, and SC, highlighting the role of tumor histology in surgical decisions. For MC, sub-lobar resection appears comparable to lobectomy. Prospective studies are needed to confirm these findings.