Prognosis of segmentectomy and lobectomy for clinical T1c solid-dominant lung cancer

The optimal surgical extent for clinical T1c solid-dominant non-small cell lung cancer (NSCLC) remains debated. This study aimed to compare the recurrence-free survival (RFS) and overall survival (OS) between segmentectomy and lobectomy in patients with clinical T1c solid-dominant NSCLC.

We retrospectively analyzed 888 patients with clinical T1c solid-dominant NSCLC [tumor diameter: 2-3 cm; consolidation-to-tumor ratio (CTR) >0.5] who underwent segmentectomy of the dominant pulmonary segment or lobectomy. Clinical characteristics, 5-year RFS, and 5-year OS were evaluated. Propensity score matching (PSM, 1:1) and subgroup Cox regression models were employed to adjust for confounders.

Of the 888 eligible cases, segmentectomy and lobectomy were performed in 55 and 833 patients, respectively. The difference in the 5-year OS between segmentectomy and lobectomy was found to be statistically significant (91.7% vs. 84.3%, P=0.02), which was also showed in the propensity score analysis (91.7% vs. 90.0%; P=0.08), with a median follow-up time of 46 months. The 5-year RFS did differ significantly between segmentectomy and lobectomy (89.46% vs. 71.50%; P=0.02), but it shown no difference in the propensity score analysis (89.46% vs. 81.5%; P=0.26).

The results indicate that segmentectomy of dominant pulmonary segment is superior to lobectomy in terms of OS for solid-dominant NSCLC cases with a tumor diameter between 2 and 3 cm.