Sublobar Resection in Stage I Non-Small Cell Lung Cancer With Lymphovascular Invasion

Stage I lung cancer ≤2 cm is routinely being managed with sublobar (wedge or segmentectomy) resection. However, whether patients with lymphovascular invasion (LVI), an indicator of aggressive disease, gain similar benefits, is debated.

A retrospective cohort analysis was conducted of 245 adult patients who underwent a resection for stage I non-small cell lung cancer (NSCLC) ≤2 cm at an academic institution from 2016 to 2022. Baseline characteristics were compared between patients with and without LVI. Overall survival and cumulative recurrence were compared using the Kaplan-Meier method.

LVI was present in 44 of 245 patients (18%) who underwent a resection for stage I lung cancer ≤2 cm. There was no difference in LVI based on comorbidities or pulmonary function. Patients with LVI were more likely to have poorly differentiated grade (59% vs 21%, P < .0005) and larger tumor size (1.6 cm vs 1.3 cm, P = .0002). Patients with LVI-positive stage I disease ≤2 cm had significantly reduced overall survival (P = .020); however, there was no difference in overall survival within LVI-positive patients when stratified by sublobar vs lobar resection extent (P = .517). In stage I disease ≤2 cm, LVI-positive patients had increased cumulative recurrence compared with those without LVI (P = .007); however, there was no difference in cumulative recurrence within LVI-positive patients when stratified by sublobar vs lobar resection type (P = .756).

For stage I NSCLC ≤2 cm with LVI-positive disease, there is no statistically significant difference in overall survival or cumulative recurrence between sublobar and lobar resections. Thus, a completion lobectomy likely offers no meaningful clinical benefit in this patient population.