Segmentectomy vs Lobectomy for Early Non-Small Cell Lung Cancer With Visceral Pleural Invasion

ABSTRACT

BACKGROUND

Recent prospective trials have demonstrated the non-inferiority of segmentectomy to lobectomy in the surgical management of early non-small-cell lung cancer (NSCLC). It remains unknown, however, whether segmentectomy is sufficient for treating small tumors with visceral pleural invasion (VPI), a known indicator of aggressive disease biology and poor prognosis in NSCLC.

METHODS

Patients in the National Cancer Database (2010-2020) with cT1a-bN0M0 NSCLC and VPI and additional high-risk features who underwent segmentectomy or lobectomy were identified for analysis. Only patients with no comorbidities were included in this analysis to reduce selection bias. Overall survival of patients who underwent segmentectomy vs. lobectomy was evaluated using multivariable-adjusted Cox proportional hazards and propensity-score matched analysis. Short-term and pathologic outcomes were also evaluated.

RESULTS

Of the 2,568 patients with cT1a-bN0M0 NSCLC and VPI included in our overall cohort, 178 (7%) underwent segmentectomy and 2,390 (93%) underwent lobectomy. There were no significant differences in 5-year overall survival between patients undergoing segmentectomy vs. lobectomy in multivariable-adjusted and propensity-score matched analysis (aHR 0.91, [95% CI: 0.55-1.51], p=0.72; 86% [95% CI: 75%-92%] vs. 76% [95% CI: 65%-84%], p=0.15). There were also no differences in surgical margin positivity, 30-day readmission, and 30- and 90-day mortality between patients undergoing either surgical approach.

CONCLUSIONS

In this national analysis, there were no differences in survival or in short-term outcomes between patients undergoing segmentectomy vs. lobectomy for early-stage NSCLC with VPI. Our findings suggest that if VPI is detected after segmentectomy for cT1a-bN0M0 tumors, completion lobectomy is unlikely to confer additional survival advantage.