Lobar vs Sublobar Lung Resection for Early-Stage Epidermal Growth Factor Receptor-Mutant Non-Small Cell Lung Cancer

Randomized controlled trials have shown that sublobar resections for small peripheral non-small cell lung cancer (NSCLC) are oncologically noninferior to lobar resections. However, these studies did not factor in epidermal growth factor receptor (EGFR) mutations. In this context, we sought to determine survival differences between sublobar and lobar resection for EGFR-mutant vs wild-type NSCLC.

We identified adult patients with ≤2 cm NSCLC tested for EGFR mutations between 2021 and 2022 from a national hospital-based data set. Patients were split into sublobar and lobar resection groups. The main outcome was 3-year overall survival. We used propensity score matching to account for patient demographic and tumor characteristics. Kaplan-Meier survival analyses were used to estimate overall survival.

There were 6918 patients, with 2673 (38.6%) undergoing sublobar resections and 4245 (61.4%) undergoing lobar resections. EGFR mutations were present in 380 (14.2%) sublobar resections and in 715 (16.8%) lobar resections. Patients with EGFR-mutant NSCLC were more likely to be women (74.3% vs 62.0%, P < .001) and Asian (13.9% vs 3.2%, P < .001). Regardless of resection extent, patients with EGFR-mutant lung cancer had better overall survival compared with EGFR-wild-type tumors (94.3% vs 86.8%, P < .001). Sublobar and lobar resections for EGFR-mutant tumors had similar survival (95.3% vs 93.7%, P = .34), whereas sublobar resections for EGFR-wild-type tumors had worse survival than lobar resections (84.5% vs 88.3%, P = .002).

EGFR testing before surgery may help guide surgical decision-making when selecting lobar vs sublobar resections.