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Surgical Patterns and Survival Outcomes in Young Women With Early-Stage Lung Adenocarcinoma: A Population-Based
Shouyong Xiao1, Siyun Wu2, Xianfeng Shao1
1Department of Thoracic Surgery I, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Peking University Cancer Hospital Yunnan, Kunming, Yunnan, China.
Background:
Early-onset lung cancer in women is increasingly associated with prolonged survival. How contemporary surgical practice aligns with this changing clinical context remains incompletely understood.
Methods:
Population-level trends in incidence, mortality, and disability-adjusted life years (DALYs) among females aged 15-49 years were assessed using Global Burden of Disease (GBD) Study 2023 estimates. Individual-level surgical patterns and outcomes were examined using the Surveillance, Epidemiology, and End Results (SEER) database for women aged 18-49 years with Stage I lung adenocarcinoma treated with lobectomy, segmentectomy, or wedge resection. To address changing surgical standards, procedure use was also summarized by calendar period and tumor size. Overall survival (OS), cancer-specific mortality, restricted mean survival time (RMST), and conditional survival were evaluated as planned analyses.
Results:
At the population level, mortality declined more rapidly than DALYs, resulting in a growing separation between deaths and long-term disease burden. Among 449 young women identified in the main SEER surgical cohort, lobectomy was the most frequently performed procedure, including for tumors ≤ 10 mm (63.5%), whereas segmentectomy was used infrequently (4.9%). Descriptive temporal analysis showed that this predominance was strongest in earlier calendar periods and attenuated over time: among localized lung adenocarcinomas measuring 1-20 mm, lobectomy decreased from 85.4% of resections in 2000-2007 to 73.9% in 2016-2022, while segmentectomy increased from 1.2% to 6.7%. For tumors ≤ 10 mm, lobectomy decreased from 73.5% to 50.0%, and segmentectomy increased from 2.9% to 17.9%. Kaplan-Meier curves followed similar trajectories over 5 years (log-rank p = 0.78). In adjusted competing risks analyses, cancer-specific mortality after segmentectomy was comparable to that observed after lobectomy (HR 1.79; 95% CI 0.54-5.92; p = 0.340).
Conclusions:
Among young women with early-stage lung adenocarcinoma, lobectomy was the predominant operation across the historical SEER observation period, but this finding should be interpreted in the context of evolving surgical standards and increasing contemporary use of parenchymal-sparing surgery. Segmentectomy appears feasible in selected patients, although the small segmentectomy sample and registry design preclude causal claims of equivalence.
