Segmentectomy versus lobectomy for small‐sized pure solid non–small cell lung cancer

• Published in: Thoracic cancer Vol. 14; no. 11; pp. 1021 - 1028
• Main Authors: Li, Zhihua, Xu, Wenzheng, Pan, Xianglong, Wu, Weibing, Chen, Lian
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.04.2023; John Wiley & Sons, Inc; Wiley
• Subjects: Carcinoma, Non-Small-Cell Lung - pathology; Disease-Free Survival; Humans; lobectomy; Lung cancer; Lung Neoplasms - pathology; Lymphatic system; Medical imaging; Medical prognosis; Metastasis; Neoplasm Staging; NSCLC; Original; Pneumonectomy; propensity score matching; pure solid nodule; Regression analysis; Retrospective Studies; segmentectomy; Thoracic surgery; Tomography; Tumors; lobectomy; propensity score matching; segmentectomy; pure solid nodule; NSCLC
• ISSN: 1759-7706; 1759-7714; 1759-7714
• DOI: 10.1111/1759-7714.14840

Background Segmentectomy has been recommended for ground glass opacity (GGO)‐dominant small‐sized non–small cell lung cancer (NSCLC) or those with GGO component. Pure solid NSCLC is a special sub‐type and has an inferior prognosis. Whether segmentectomy could achieve comparable long‐term outcomes with lobectomy for pure solid small‐sized NSCLC remained controversial. This study aimed to compare the prognosis of segmentectomy and lobectomy for pure solid NSCLC. Methods NSCLC patients with a pure solid nodule (≤2 cm) who received segmentectomy or lobectomy between January 2010 and June 2019 were retrospectively screened. Log‐rank test, univariable, and multivariable Cox regression analyses were used for prognostic comparison. Further, the propensity score matching analysis was adopted to yield a matched cohort. Results After screening, 344 pure solid NSCLC patients with a median follow‐up time of 56 months were reserved. Among them, 98 patients underwent segmentectomy and the other 246 subjects received lobectomy. The lobectomy group had a larger tumor size, a higher rate of lymph node metastasis than the segmentectomy arm. Generally, patients with segmentectomy had a better disease‐free survival (DFS) (p = 0.011) and overall survival (OS) (p = 0.028) than those with lobectomy. However, the multivariable Cox regression analysis indicated that no significant survival difference existed between segmentectomy and lobectomy after adjusting the potential confounding factors (DFS: hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.30–1.77, p = 0.476; OS: HR, 0.36; 95% CI, 0.08–1.59, p = 0.178). Consistently, in the propensity score matched cohort, segmentectomy (n = 74) yielded similar DFS (p = 0.960) and OS (p = 0.320) with lobectomy (n = 74). Conclusions Segmentectomy could achieve comparable oncological outcomes with lobectomy for pure solid small‐sized NSCLC. Segmentectomy could achieve equivalent disease‐free survival and overall survival with lobectomy for pure solid small‐sized (≤2 cm) non–small cell lung cancer.