Lobectomy versus sub-lobectomy for clinical stage IA (≤2cm) lung squamous cell carcinoma with tumor spread through air spaces: A multi-center retrospective study

Abstract OBJECTIVES The efficacy of sub-lobectomy for clinical IA (tumors ≤2cm) lung squamous cell carcinoma with tumor spread through air spaces remains unknown. This study compares long-term survival outcomes between sub-lobectomy and lobectomy, aiming to offer pivotal evidence for optimizing resection strategies for clinical IA spread through air spaces-positive squamous cell carcinoma patients. METHODS Consecutive clinical IA spread through air spaces-positive squamous cell carcinoma patients undergoing surgery between 2010 and 2020 at seven high-volume institutions across five Chinese cities were retrospectively reviewed. The primary endpoint was overall survival, and the secondary endpoint was recurrence-free survival. Propensity-score matching was employed to mitigate selection bias. RESULTS A total of 870 patients were included, and propensity-score matching yielded 476 and 238 cases in the Lobe and Sub-lobe groups, respectively. Over an estimated median follow-up of 6.51 years, lobectomy significantly improved overall survival [hazard ratio[95% confidence interval]=0.598[0.447-0.761],P<0.001)] and recurrence-free survival (hazard ratio[95% confidence interval]=0.572[0.449-0.733],P<0.001), and reduced postoperative mortality (30.7% vs. 40.3%,P=0.010) and recurrence (39.3% vs. 55.0%,P<0.001) incidences compared to sub-lobectomy. Further subgroup analysis revealed that lobectomy improved survival outcomes over sub-lobectomy in younger (age <70 years) and clinical IA2 sub-cohorts, while the two approaches yielded comparable survival outcomes for elderly (age ≥70 years) and clinical IA1 sub-cohorts. CONCLUSIONS Lobectomy improved survival outcomes over sub-lobectomy for clinical IA spread through air spaces-positive squamous cell carcinoma and thus might be preferred for clinical IA squamous cell carcinoma patients with highly suspected spread through air spaces. The prognostic benefits of lobectomy may be discriminated by age and clinical stage.