Segmentectomy versus lobectomy for centrally located small-sized and radiologically pure-solid non–small cell lung cancer

Objectives

This study aimed to compare segmentectomy and lobectomy in centrally located, small-sized (≤2 cm), radiologically pure-solid cN0 non–small cell lung cancer, particularly focusing on hypermetabolic tumors, because the feasibility of segmentectomy for centrally located, more aggressive non–small cell lung cancer remains uncertain.

Methods

We retrospectively evaluated 214 patients with centrally located small-sized (≤2 cm) and radiologically pure-solid cN0 non–small cell lung cancer who underwent segmentectomy (n = 82) or lobectomy (n = 132) at 3 institutions. Tumors located in the inner two-thirds of the pulmonary parenchyma were defined as centrally located. Propensity score matching was used to balance the baseline characteristics. Hypermetabolic tumors were identified based on the maximum standard uptake value, with high-grade malignancy indicated by the presence of pleural or lymphovascular invasion, or lymph node metastasis, as predicted by receiver operating characteristic curve.

Results

High-grade malignancy was confirmed in 115 patients (53.7%). After propensity score matching, no significant differences in clinical baseline characteristics were found among the 66 matched patients. Overall survival and recurrence-free survival did not significantly differ between segmentectomy and lobectomy groups (P = .253 and P = .463, respectively). Propensity score–adjusted multivariable Cox analysis revealed that segmentectomy was not an independent prognostic factor for overall survival or recurrence-free survival (P = .630 and P = .966, respectively). Regarding hypermetabolic tumors (maximum standard uptake value ≥2.65), overall survival and recurrence-free survival did not differ significantly between segmentectomy (n = 35) and lobectomy (n = 95) (P = .874 and P = .476, respectively).

Conclusions

Segmentectomy may be a feasible alternative to lobectomy in patients with centrally located, small-sized, and radiologically pure-solid non–small cell lung cancer, even in those with high-grade malignancy.