Lobectomy is the preferred choice than sublobar resection for centrally located clinical stage i non-small cell lung cancer

Abstract OBJECTIVES Tumour location can affect clinicians’ decisions regarding the surgical procedure, especially when choosing between lobectomy and segmentectomy. The biological behaviour of clinical stage I non-small-cell lung cancer may differ based on tumour location. We aimed to explore the biological behaviour of centrally located clinical stage I non-small-cell lung cancer and to identify which surgical procedure is more appropriate for such tumors. METHODS This retrospective study included 719 patients who underwent curative surgery for stage I non-small-cell lung cancer between April 2004 and December 2023. The biological behaviour of the tumors was analyzed based on tumour location. Overall and recurrence-free survivals in patients who underwent lobectomy or more extensive procedures, including hilar and mediastinal lymph node dissection, were assessed based on tumour location. RESULTS A total of 124 (17.2%) and 595 (82.8%) patients were included in the centrally located and peripherally located groups, respectively. The centrally located group had a significantly higher standardized uptake value maximum on positron emission tomography/computed tomography, a higher-grade adenocarcinoma subtype, and a higher frequency of lymph node metastasis than the peripherally located group. In multivariable analysis, centrally located and radiologically pure solid tumors (consolidation/tumour ratio = 1) were significant factors for occult lymph node metastasis. No significant difference was observed in survival based on tumour location. CONCLUSIONS Centrally located clinical stage I non-small-cell lung cancers tend to be hypermetabolic and have a potential risk of lymph node metastasis. Lobectomy could be a better treatment option for centrally located clinical stage I non-small-cell lung cancer.