Factors determining the feasibility of segmentectomy for central non-small cell lung cancer and construction of a...

Multiple studies have demonstrated that segmentectomy is feasible and can yield long-term outcomes comparable to lobectomy for selected central non-small cell lung cancer (NSCLC). This study aimed to identify factors influencing the feasibility of segmentectomy for central NSCLC, and to develop a predictive nomogram.

Patients with central NSCLC ≤2 cm who underwent segmentectomy or lobectomy between 2020 and 2024 were screened. Patients were split into two groups based on their surgical date (Training set: 2020-2023 and Validation set: 2024). The least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analyses were performed to identify potential predictors. Qualified segmentectomy (surgical margin ≥ maximum tumor diameter) was classified as 0, while lobectomy or unqualified segmentectomy was classified as 1. A nomogram was developed based on these identified predictors.

There were 303 and 105 patients in the training set and validation set, respectively. The probability of achieving sufficient margins during segmentectomy was 83.9 % in the training set and 81.3 % in the validation set. After LASSO and multivariable logistic regression analyses, four variables were retained: tumor size (OR = 3.81, P = 0.006), radiological type (solid vs. subsolid, OR = 5.39, P = 0.009), tumor-to-segmental bronchus distance (OR = 0.64, P = 0.036), and number of tumor-involved subsegments (OR = 1.54, P < 0.001). The nomogram developed from these predictors exhibited good predictive ability, with an area under the curve of 0.793 in the training set and 0.777 in the validation set.

Tumor size, radiological type, tumor-to-segmental bronchus distance, and number of tumor-involved subsegments influenced the feasibility of segmentectomy for central NSCLC.