Segmentectomy Versus Lobectomy in NSCLC With Pathologically Invasive Features: A Post Hoc Supplementary Analysis of...

Segmentectomy has become a standard treatment for small-sized peripheral NSCLC. However, its advantages compared with lobectomy in NSCLC harboring pathologically invasive features remain unclear.

We conducted a post hoc supplementary analysis of randomized controlled phase 3 trial JCOG0802/WJOG4607L in patients with clinical stage IA NSCLC (≤2 cm) harboring one or more of the following pathologically invasive features: lymphatic, vascular, or pleural invasion and lymph node metastasis. The primary outcome was overall survival (OS), and secondary outcomes were relapse-free survival, cumulative incidence of locoregional relapse, lung cancer-specific death, and death from other causes.

Of the 1106 participants randomly assigned to the lobectomy or segmentectomy arm, 298 (27%) were included in this analysis: 164 patients were in the lobectomy arm and 134 in the segmentectomy arm. At a median follow-up of 7.1 (interquartile range: 5.9-8.4) years, segmentectomy demonstrated a trend toward better OS than lobectomy, with hazard ratio (HR) of 0.657 (95% confidence interval [CI]: 0.401-1.077; p = 0.0936). The cumulative incidence of death from other causes was significantly reduced in the segmentectomy arm compared with the lobectomy arm (HR = 0.359 [95% CI: 0.143-0.900]). Relapse-free survival and cumulative incidence of lung cancer-specific death were not significantly different between the two arms, whereas the cumulative incidence of locoregional relapse was significantly higher in the segmentectomy than in the lobectomy arm (HR = 2.234 [95% CI: 1.334-3.741]).

Segmentectomy demonstrated better OS compared with lobectomy even for NSCLC harboring pathologically invasive features. However, the risk of locoregional relapse after segmentectomy should be considered.