Comparison of Outcomes Between Ablation and Lobectomy in Stage  IA Non‐Small Cell Lung Cancer: A Retrospective Multicenter Study

BACKGROUND AND OBJECTIVE: Image-guided thermal ablation (IGTA) has been increasingly used in patients with stage IA non-small cell lung cancer (NSCLC) without surgical contraindications, but its long-term outcomes compared to lobectomy remain unknown. This study aims to evaluate the long-term outcomes of IGTA versus lobectomy and explore which patients may benefit most from ablation. METHODS: After propensity score matching, a total of 290 patients with stage IA NSCLC between 2015 and 2023 were included. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. A Markov model was constructed to evaluate cost-effectiveness. Finally, a radiomics model based on preoperative computed tomography (CT) was developed to perform risk stratification. RESULTS: After matching, the median follow-up intervals were 34.8 months for the lobectomy group and 47.2 months for the ablation group. There were no significant differences between the groups in terms of 5-year PFS (hazard ratio [HR], 1.83; 95% CI, 0.86-3.92; p = 0.118) or OS (HR, 2.44; 95% CI, 0.87-6.63; p = 0.092). In low-income regions, lobectomy was not cost-effective in 99% of simulations. The CT-based radiomics model outperformed the traditional TNM model (AUC, 0.759 vs. 0.650; p < 0.01). Moreover, disease-free survival was significantly lower in the high-risk group than in the low-risk group (p = 0.009). CONCLUSION: This study comprehensively evaluated IGTA versus lobectomy in terms of survival outcomes, cost-effectiveness, and prognostic prediction. The findings suggest that IGTA may be a safe and feasible alternative to conventional surgery for carefully selected patients.