The Journal of thoracic and cardiovascular surgery · 2025
Lobectomy improves disease-free survival over sublobar resection for high-risk stage IA non-small cell lung cancer.
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Caso Raul, Zhou Nanruoyi, Skovgard Matthew, Toumbacaris Nicolas, Tan Kay See, Adusumilli Prasad S, Bains Manjit S, Bott Matthew J, Downey Robert J, Huang James, Isbell James M, Molena Daniela, Park Bernard J, Rocco Gaetano, Rusch Valerie W, Sihag Smita, Jones David R, Gray Katherine D
Аннотация
OBJECTIVE: To investigate disease-free survival (DFS) of sublobar resection versus lobectomy for stage IA non-small cell lung cancer (NSCLC) with preoperative high-risk features.
METHODS: Data were abstracted from a prospective database to identify patients with clinical T1a-T1bN0M0 NSCLC (≤2 cm) who underwent lobectomy or sublobar resection (wedge resection or segmentectomy). 1:1 propensity matching was used to balance the dataset for forced expiratory volume in 1 second ≥60% and high-risk features: cT1b versus cT1a, standard uptake value of the primary tumor on positron emission tomography, solid versus subsolid tumor texture on computed tomography, and micropapillary/solid histology. The primary outcome was DFS.
RESULTS: In total, 825 patients met inclusion criteria: 52% (n = 426) patients underwent lobectomy and 48% (n = 399) of patients underwent sublobar resection (45% segmentectomy, 55% wedge resection). Lobectomy was associated with more preoperative high-risk features: cT1b (P < .001), greater standard uptake value (P < .001), solid tumor texture on computed tomography (P < .001), and micropapillary/solid histology (P < .001). In total, 660 patients were included in the matched analysis with all high-risk features balanced. Nodal upstaging (N1) was greater in patients who underwent lobectomy (9.1% vs 3.4%, P = .004). Five-year DFS (85% vs 74%, P = .12) was equivalent in the matched cohort. Lobectomy was protective for recurrence in the presence of 2 or greater high-risk features: sublobar resection patients with 2 high-risk features (hazard ratio, 1.77; 95% confidence interval, 1.13-2.76, P = .012) or 3-4 high-risk features (hazard ratio, 1.97; 95% confidence interval, 1.25-3.10, P = .004) had worse DFS.
CONCLUSIONS: Lobectomy should be considered over sublobar resection for stage IA NSCLC ≤2 cm in the presence of multiple high-risk features.
METHODS: Data were abstracted from a prospective database to identify patients with clinical T1a-T1bN0M0 NSCLC (≤2 cm) who underwent lobectomy or sublobar resection (wedge resection or segmentectomy). 1:1 propensity matching was used to balance the dataset for forced expiratory volume in 1 second ≥60% and high-risk features: cT1b versus cT1a, standard uptake value of the primary tumor on positron emission tomography, solid versus subsolid tumor texture on computed tomography, and micropapillary/solid histology. The primary outcome was DFS.
RESULTS: In total, 825 patients met inclusion criteria: 52% (n = 426) patients underwent lobectomy and 48% (n = 399) of patients underwent sublobar resection (45% segmentectomy, 55% wedge resection). Lobectomy was associated with more preoperative high-risk features: cT1b (P < .001), greater standard uptake value (P < .001), solid tumor texture on computed tomography (P < .001), and micropapillary/solid histology (P < .001). In total, 660 patients were included in the matched analysis with all high-risk features balanced. Nodal upstaging (N1) was greater in patients who underwent lobectomy (9.1% vs 3.4%, P = .004). Five-year DFS (85% vs 74%, P = .12) was equivalent in the matched cohort. Lobectomy was protective for recurrence in the presence of 2 or greater high-risk features: sublobar resection patients with 2 high-risk features (hazard ratio, 1.77; 95% confidence interval, 1.13-2.76, P = .012) or 3-4 high-risk features (hazard ratio, 1.97; 95% confidence interval, 1.25-3.10, P = .004) had worse DFS.
CONCLUSIONS: Lobectomy should be considered over sublobar resection for stage IA NSCLC ≤2 cm in the presence of multiple high-risk features.