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Lobar vs Sublobar Lung Resection for Early-Stage Epidermal Growth Factor Receptor-Mutant Non-Small Cell Lung Cancer
Alexander Pohlman1, Bilal Odeh2, Wissam Raad2
1Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois; Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois; Department of Surgery, University of Illinois Chicago, Chicago, Illinois.
The Annals of Thoracic Surgery
|April 4, 2026
Summary
EGFR testing is crucial for non-small cell lung cancer (NSCLC) surgery. Sub-lobar resections are effective for EGFR-mutant NSCLC, but lobar resections are better for EGFR wild-type tumors.
Area of Science:
- Thoracic Surgery
- Oncology
- Genetics
Background:
- Previous studies on non-small cell lung cancer (NSCLC) showed sub-lobar resections were non-inferior to lobar resections.
- These studies did not account for Epidermal Growth Factor Receptor (EGFR) mutations.
- The role of EGFR mutations in surgical decision-making for NSCLC remains unclear.
Purpose of the Study:
- To investigate survival differences between sub-lobar and lobar resections in EGFR-mutant versus EGFR wild-type NSCLC.
- To determine if EGFR mutation status influences the choice between sub-lobar and lobar resections for NSCLC.
Main Methods:
- A national hospital-based dataset of adult patients with ≤2cm NSCLC tested for EGFR mutations (2021-2022) was analyzed.
- Patients were categorized into sub-lobar and lobar resection groups.
- Propensity score matching and Kaplan-Meier survival analyses were used to compare 3-year overall survival.
Main Results:
- EGFR-mutant NSCLC patients had significantly better overall survival (94.3%) compared to EGFR wild-type (86.8%).
- Sub-lobar and lobar resections showed similar survival for EGFR-mutant NSCLC (95.3% vs 93.7%).
- Sub-lobar resections for EGFR wild-type NSCLC had worse survival (84.5%) compared to lobar resections (88.3%).
Conclusions:
- EGFR mutation status is a significant factor in NSCLC patient survival.
- Sub-lobar resection is oncologically equivalent to lobar resection for EGFR-mutant NSCLC.
- EGFR testing before surgery can guide the choice between lobar and sub-lobar resections for NSCLC.
