Similar overall survivals of wedge resection and segmentectomy in stage IA1 non-small cell lung cancer: a population-based study using propensity score matching and coarsened exact matching.

Background: Controversy continues over the application of wedge resection and segmentectomy for the early stage of non-small cell lung cancer (NSCLC) without affecting long-term survival. This study aimed to investigate the acceptability of wedge resection as an alternative to segmentectomy in patients with T1aN0M0 NSCLC with data from the Surveillance, Epidemiology, and End Results (SEER) database.

Methods: A total of 742 patients with pT1aN0M0 NSCLC from the SEER database were finally involved in this study, including 130 patients in the segmentectomy group and 612 patients in the wedge resection group. Three matching methods, including propensity score matching (PSM), coarsened exact matching (CEM), and inverse probability of treatment weighting using the propensity score (IPTW) were introduced to control and minimize the potential bias. Prognostic analysis was conducted using the Kaplan-Meier method and Cox regression after matching the two groups (P<0.02).

Results: After matching, wedge resection and segmentectomy pairs were well matched without significant differences in all clinical and tumor factors. The prognostic analysis of overall survival (OS) showed no significant difference between wedge resection and segmentectomy in PSM analysis (log-rank test, P=0.08), IPTW analysis (log-rank test, P=0.09), and CEM analysis (log-rank test, P=0.03), respectively. The multivariant Cox analysis revealed that age (P<0.001), sex (P<0.001), histology (P<0.001) and grade (P=0.004) were significant independent prognostic factors for OS.

Conclusions: Wedge resection could be an alternative procedure for patients with pT1aN0M0 NSCLC without affecting survival.