Anatomic Lung Resection is Associated with Improved Survival Compared with Wedge Resection for Stage IA (≤2 cm) Non-Small Cell Lung Cancer.

Abstract

Introduction: Given the uncertain generalizability of recent clinical trial data, a comparative effectiveness analysis examining the long-term survival of "real world" patients may clarify the role of lobectomy and sublobar resection (segmentectomy or wedge resection) in the treatment of early-stage non-small cell lung cancer (NSCLC).

Methods: Adult patients undergoing lung resection for clinical stage IA NSCLC (≤2 cm) between 2012 and 2022 were identified from the Society of Thoracic Surgeons General Thoracic Surgery Database. Long-term vital status was determined by linkage to the National Death Index and Centers for Medicare & Medicaid Services inpatient data. The primary endpoint was overall survival (OS); secondary endpoints included lung cancer-specific survival (LCSS). Stabilized inverse probability weighted Cox Regression was used to account for selection bias and derive hazard ratios (HR) with 95% confidence intervals comparing the lobectomy, segmentectomy, and wedge resection cohorts.

Results: Overall, 32,340 stage IA NSCLC patients (19,778 lobectomies [OS=71.9% (5-year), 44.8% (10-year)], 4,279 segmentectomies [OS=69.6%, 44.2%], and 8,283 wedge resections [OS=66.3%, 41.4%]) were examined. After risk adjustment, lobectomy was associated with improved OS and LCSS compared to sublobar resection [HR(OS)=0.87(0.83-0.92); HR(LCSS)=0.84(0.73-0.97)]. Both lobectomy [HR(OS)=0.84(0.80-0.88); HR(LCSS)=0.72(0.56-0.93)] and segmentectomy [HR(OS)=0.88(0.81-0.95); HR(LCSS)=0.77(0.66-0.89)] were associated with improved survival compared to wedge resection. No differences in OS or LCSS were observed between lobectomy and segmentectomy.

Conclusion: In routine clinical practice, lobectomy and segmentectomy are associated with improved overall and lung cancer-specific survival compared with wedge resection for stage IA NSCLC (≤2 cm). These findings highlight the potential gap between trial efficacy and real-world effectiveness.