Conditional Survival of Patients With Early‐Stage Non‐Small Cell Lung Cancer Who Undergo Lobectomy, Segmentectomy, or Wedge Resection Using the NCDB

ABSTRACT Background and Objectives Randomized clinical trials have shown that sub‐lobar resection for clinical stage (cStage) IA non‐small cell lung cancer (NSCLC) is non‐inferior to lobar resection. We evaluated traditional and conditional survival differences between lobectomy, wedge resection, and segmentectomy in patients with cStage IA NSCLC. Methods The National Cancer Database (2004–2019) was queried for patients with cStage IA (≤ 2 cm) NSCLC who underwent upfront lobectomy, segmentectomy, or wedge resection. Patients were stratified by extent of resection. Propensity‐matched traditional (TSA) and conditional (CSA) survival analyses were performed. Propensity score included age, gender, histology, tumor grade, and Charlson‐Deyo score. Number of lymph nodes (LN) harvested was also compared between groups. Results There were 46 395 patients who met the inclusion criteria, of whom 32 599 (70.3%) received lobectomy, 11 181 (24.1%) wedge resection, and 2615 (5.6%) segmentectomy. Following propensity matching, all groups contained 2615 patients. In the TSA, segmentectomy (hazard ratio [HR]: 1.19, 95% confidence interval [CI]: 1.08–1.32) and wedge resection (HR: 1.41, CI: 1.28–1.56) were associated with worse 5‐year survival. This remained significant in CSA at 3‐ and 5‐years post‐resection in patients who underwent segmentectomy (HR: 1.24, CI: 1.08–1.43 and HR: 1.23, CI: 1.02–1.49, respectively) and wedge resection (HR: 1.42, CI: 1.24–1.63 and HR: 1.33, CI: 1.11–1.59, respectively). Wedge resection and segmentectomy were associated with a lower number of harvested LN (median = 4 and 6, respectively) compared to lobectomy (8, p < 0.001). Conclusion Analysis of real‐world data suggests that lobectomy is associated with improved traditional and conditional 5‐year survival as well as LN harvest.