Non‐Small Cell Lung Cancer Patients With Tumors ≤ 2 Cm Are Suitable for Wedge Resection or Segmentectomy: A Real‐World Study

Whether wedge resection is oncological suitable for ground glass opacity (GGO)-dominant non-small cell lung cancer (NSCLC) ≤2cm is still debatable. The aim of this study is to investigate the short-term and long-term outcomes of intentional wedge resection and segmentectomy for those patients. This was a real-world study from one of the largest thoracic surgery centers in West China. Patients who underwent intentional wedge resection or segmentectomy for ≤2cm CTR (consolidation-to-tumor) ≤0.5 NSCLC were consecutively included between December 2009 and December 2018. Data were prospectively collected and retrospectively reviewed. Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics. Long-term outcomes, including overall survival (OS), recurrence-free survival (RFS), and lung cancer-specific survival (LCSS), were analyzed using Cox proportional model. A total of 1209 patients were included (497 in the wedge resection group, 712 in the segmentectomy group). Compared to segmentectomy, wedge resection had a significantly lower rate of complications (3.8 vs. 7.7%, P =0.008), a shorter operating time (65min vs. 114min, P <0.001), and a shorter postoperative stay (3 days vs. 4 days, P <0.001). The median follow-up was 70.1 months. The multivariate Cox model indicated that wedge resection had survival outcomes that were similar to segmentectomy in terms of 5-year OS (98.8 vs. 99.6%, HR=1.98, 95% CI: 0.59-6.68, P =0.270), 5-year RFS (98.8 vs. 99.5%, HR=1.88, 95% CI: 0.56-6.31, P =0.307) and 5-year LCSS (99.9 vs. 99.6%, HR=1.76, 95% CI: 0.24-13.15, P =0.581). Intentional wedge resection is an appropriate choice for ≤2cm GGO-dominant NSCLC.

Long-standing controversy has existed over whether sublobar resection is an adequate oncological procedure for clinical stage IA non-small cell lung cancer (NSCLC) ≤2 cm, despite the recent randomized trial reports of Japanese Clinical Oncology Group (JCOG) 0802 and Cancer and Leukemia Group B (CALGB) 140503 demonstrating non-inferior outcomes with sublobar resection compared to lobectomy. As practice patterns shift, we sought to compare oncologic outcomes in patients with these early-stage tumors after wedge resection, segmentectomy, or lobectomy in a contemporary, real-world, cohort. A retrospective review of a prospectively maintained database from a single institution was conducted from 2011 to 2020 to identify all patients with clinically staged IA1 or IA2 NSCLC (tumors ≤2 cm with no nodal involvement). The primary outcomes of interest were overall survival (OS) and disease-free survival (DFS), with secondary outcomes of lung cancer-specific survival (LCSS), recurrence patterns, and perioperative morbidity and mortality. A total of 480 patients were identified; 93 (19.4%) patients underwent wedge resection, 90 (18.7%) received segmentectomy, and 297 (61.9%) underwent lobectomy. Patients who underwent wedge resection had worse Eastern Cooperative Oncology Group (ECOG) performance status (23.7% ECOG 1 or 2 vs. 5.6% among segmentectomy and 5.4% among lobectomy, P<0.05). Both wedge resection and segmentectomy patients had lower preoperative mean percentage of predicted forced expiratory volume in one second (%FEV1) compared to the lobectomy group (81.8% and 82.6% vs. 89.6%, P=0.002), a higher proportion of patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD), and a higher Charlson Comorbidity Index. There were no statistically significant differences in 5-year OS, DFS, or LCSS between groups: 90%, 61%, 78% for wedge resections compared with 85%, 75%, 86% for segmentectomy, and 87%, 77%, 87% for lobectomy, respectively. Recurrence was observed in 17 patients who underwent wedge resection (18.3%, 8 local, 9 distant), 12 patients who received segmentectomy (13.4%, 6 local, 6 distant), and 38 patients who underwent lobectomy (12.8%, 11 local, 27 distant), which was not significantly different (P=0.36). Patients with inferior performance status or lower baseline pulmonary function are more likely to receive wedge resection for clinical stage IA NSCLC ≤2 cm in size. For these small tumors, lobectomy, segmentectomy, and wedge resection provide comparable oncologic outcomes.

Sublobar resection (wedge resection and segmentectomy) has been established as an oncologically equivalent option to lobectomy for early-stage patients with non-small cell lung cancer (NSCLC) ≤ 2 cm. However, the optimal approach of sublobar resection remains subject to debate. In the present study we aimed to compare the oncological outcomes of wedge resection and segmentectomy in these patients. We identified patients with pT1a-bN0M0 NSCLC who underwent wedge resection and segmentectomy from the Surveillance, Epidemiology, and End Results database between 2010 and 2020. A Cox regression model and propensity-score matching (PSM) analysis were used. Overall survival (OS) and lung cancer-specific survival (LCSS) were compared using the Kaplan-Meier method. A total of 4190 patients met our selection criteria, including wedge resection in 3137 and segmentectomy in 1053. Patients undergoing wedge resection were less likely to have total lymph nodes resected (4 vs. 7, p < 0.001). Before PSM, patients undergoing segmentectomy had a higher 5-year OS rate (87.75% vs. 82.72%; p = 0.0023), while exhibiting a similar LCSS rate (93.45% vs. 92.73%; p = 0.32). After PSM, segmentectomy consistently demonstrated significantly better OS and there was no statistically significant difference in LCSS. Analysis of causes of death revealed that a higher incidence of deaths related to other causes among patients undergoing wedge resection compared to those undergoing segmentectomy. Both wedge resection and segmentectomy yield comparable oncological outcomes for patients with NSCLC ≤ 2 cm, although segmentectomy exhibits superior OS due to less death related to other causes.

e18723 Background: Lung cancer is the leading cause of cancer death in the United States, with &gt; 85% classified as non-small cell lung cancer (NSCLC). Diabetes mellitus (DM) is a common comorbidity in patients with NSCLC. While surgery is the standard of care for early-stage NSCLC, patients who have DM with end organ damage are considered medically inoperable according to treatment guidelines and whether this influences NSCLC treatment and outcomes is unclear. This study aimed to investigate treatment patterns and outcomes among patients with early-stage NSCLC and DM. Methods: Using the Surveillance, Epidemiology, and End Results database linked to Medicare (2000-2016), we identified patients ≥65 years old with Stage I-IIIA NSCLC treated with lobectomy, limited resection (wedge resection and segmentectomy), or no surgery. DM and complications at the time of NSCLC diagnosis were ascertained through published claims-based algorithms. Patients were categorized as having no DM, DM without severe complications (DM-c), or DM with ≥1 severe complication (i.e., end-organ damage, DM+c). We used multinomial logistic regression to assess if DM was associated with treatment. Association of DM with overall survival (OS) and lung cancer-specific survival (LCSS) was analyzed with Cox regression stratified by treatment type. These analyses controlled for demographics, comorbidities, and NSCLC histology and stage. Results: Of 60,300 patients analyzed, 45,270 (75%) had no DM, 6,873 (12%) had DM-c and 7,887 (13%) had DM+c. More patients with DM+c (N = 4,508[57%]), did not receive surgery vs. patients with DM-c (N = 3,771[55%]) and without DM (N = 23,289[51%]). DM was associated with lower odds of receiving lobectomy vs. no surgery in adjusted analysis (odds ratio [OR]: 0.88; 95% confidence interval [CI]: 0.83-0.93 for DM-c, and OR: 0.91; 95% CI: 0.86-0.97 for DM+c vs. no DM), but not for limited resection vs. no surgery (OR: 0.92; 95% CI: 0.83-1.02 for DM-c and OR: 0.91; 95% CI: 0.92-1.11 for DM+c vs. no DM). Cox regression showed that in patients with lobectomy and limited resection, compared to no DM, DM+c was associated with worse OS (hazard ratio [HR]: 1.21; 95% CI: 1.15 to 1.27 [lobectomy]; HR: 1.17; 95% CI: 1.07-1.28 [limited resection]), but not LCSS (HR: 1.06; 95% CI: 0.99-1.14 [lobectomy]; HR: 1.02; 95% CI: 0.90-1.17 [limited resection]). Among patients who received no surgery, DM+c patients had both worse LCSS (HR: 1.05; 95% CI: 1.00-1.09 and OS (HR: 1.12; 95% CI: 1.08-1.16) vs. no DM. DM-c was not associated with worse LCSS or OS for all treatment categories. Conclusions: Patients with Stage I-IIIA NSCLC and DM+c were less likely to undergo surgery and had worse OS but not LCSS if they underwent full or limited resection, while they had worse OS and LCSS if they did not have surgery. These findings suggest that patients with DM with end-organ damage benefit from more aggressive NSCLC treatment, but research is needed to determine optimal treatments in these patients.

Recently, several studies have reported that the survival benefit of wedge resection might not be inferior to that of lobectomy in early-stage NSCLC patients, but there is no unified definition of the details or cutoff value. Patients with early-stage NSCLC with a tumour size ≤ 2.0 cm were chosen from the SEER database. The influence of confounding factors was minimized by 1:1 propensity score matching (PSM). Kaplan‒Meier curves and Cox proportional hazards models were used to evaluate the overall survival (OS) and lung cancer-specific survival (LCSS) of patients undergoing lobectomy and wedge resection. A total of 3891 patients with early-stage NSCLC with tumour size ≤ 2.0 cm were enrolled, of whom 2839 underwent lobectomy and 1052 underwent wedge resection. Both before and after PSM, lobectomy significantly improved OS and LCSS compared with wedge resection in the unstratified study population. In the tumour size ≤ 1 cm group, lobectomy had better OS and LCSS than wedge resection (P < 0.05) before PSM; after PSM, there was no significant difference in OS (P = 0.16) and LCSS (P = 0.17). In Grade I patients, before PSM, lobectomy was superior to wedge resection in LCSS (P = 0.038), while there was no significant difference in OS (P = 0.16); after PSM, there were no significant differences in either OS (P = 0.78) or LCSS (P = 0.11). For early-stage NSCLC patients with a tumour size ≤ 1 cm or with a tumour size ≤ 2 cm and with Grade I, there was no significant difference in survival between wedge resection and lobectomy.

Segmentectomy for small-sized stage Ia non-small cell lung cancer (NSCLC) may be comparable to lobectomy regarding prognosis and local recurrence. However, the clinical results of wedge resection for such patients are still under debate. In this international multicenter study, we retrospectively studied surgical outcomes of sublobar resections for patients with small-sized stage Ia adenocarcinoma to elucidate whether wedge resection is inferior to segmentectomy for such patients. Between March 2000 and August 2011, 173 patients underwent segmentectomy (group I), and 181 patients underwent wedge resection (group II) at three institutions in Japan and China. The tumor was defined as Ground glass opacity (GGO) type when the proportion of GGO was equal or more than 50% in HRCT, while solid type was defined as the proportion of GGO less than 50%. Clinicopathologic factors, local recurrence rate, and survival were compared. The two groups were similar in sex, comorbidity rate, and composition of Noguchi type. There was no in-hospital death. Postoperative morbidity rate of group I was significantly higher than that of group II (11.0% vs. 2.2%, P=0.016). Local recurrence rates were similar between group I (4.0%) and group II (4.4%), while no patient with GGO type tumors had local recurrence. Overall and lung cancer-specific survivals were of no significant difference between the two groups. Lung cancer-specific survival rates at 10 years were significantly better in patients with GGO type tumors than in those with solid type tumors (100% vs. 76.9%, P<0.001). In multivariate Cox regression analyses of lung cancer-specific survival of all patients, GGO type turned out to be an independent prognostic factor, while extent of resection did not have any influence. Our data suggests that sublobar resection is an acceptable procedure for small lung adenocarcinomas without nodal involvement, and wedge resection may not be inferior to segmentectomy for small GGO type tumors. Our study also demonstrates that GGO type is an independent prognostic factor of disease-free survival for small-sized (diameter ≤2.0 cm) stage Ia lung adenocarcinomas.

OBJECTIVESThe prognosis of segmentectomy and wedge resection for solid predominant early-stage non-small cell lung cancer with low metabolic activity is unclear.METHODSThis study aimed to assess patients who underwent segmentectomy or wedge resection with curative intent for clinically node-negative non-small cell lung cancer presenting as a solid predominant tumour (consolidation tumour ratio >50%) with a whole size ≤3 cm and [18F]-fluoro-2-deoxy-D-glucose accumulation weaker than that of the mediastinum tissue (Deauville score, 1 or 2) on positron emission tomography/computed tomography. The cumulative incidence of recurrence (CIR) was compared using the Gray method, and the predictive factor of CIR was analysed using the Fine and Gray method.RESULTSOf 140 patients included in this study, 93 (66.4%) underwent segmentectomy and 47 (33.6%) underwent wedge resection. No significant difference in the clinical stage was found between the 2 groups. The CIR was higher with wedge resection than with segmentectomy (P = 0.004). Recurrence after wedge resection was noted in 4 (8.5%) patients, 2 of whom had a recurrent site containing lung parenchyma of the preserved lobe and hilum lymph node, which would have been resected if segmentectomy had been performed. In the multivariable analysis for CIR using inverse probability of treatment weighting and the procedure, wedge resection was a significantly worse predictive factor (hazard ratio, 12.280; P = 0.025).CONCLUSIONSSegmentectomy rather than wedge resection should be considered for solid predominant, small-size non-small cell lung cancer even if [18F]-fluoro-2-deoxy-D-glucose accumulation is low.

According to the lung cancer staging project, T1a (≤ 2 cm) non-small-cell lung cancer (NSCLC) should be additionally classified into ≤ 1 cm and > 1 to 2 cm groups. This study aimed to investigate the surgical procedure for NSCLC ≤ 1 cm and > 1 to 2 cm. We identified 15,760 patients with T1aN0M0 NSCLC after surgery from the Surveillance, Epidemiology, and End Results database. Overall survival (OS) and lung cancer-specific survival (LCSS) were compared among patients after lobectomy, segmentectomy, or wedge resection. The proportional hazards model was applied to evaluate multiple prognostic factors. OS and LCSS favored lobectomy compared with segmentectomy or wedge resection in patients with NSCLC ≤ 1 cm and > 1 to 2 cm. Multivariable analysis showed that segmentectomy and wedge resection were independently associated with poorer OS and LCSS than lobectomy for NSCLC ≤ 1 cm and > 1 to 2 cm. With sublobar resection, lower OS and LCSS emerged for NSCLC > 1 to 2 cm after wedge resection, whereas similar survivals were observed for NSCLC ≤ 1 cm. Multivariable analyses showed that wedge resection is an independent risk factor of survival for NSCLC > 1 to 2 cm but not for NSCLC ≤ 1 cm. Lobectomy showed better survival than sublobar resection for patients with NSCLC ≤ 1 cm and > 1 to 2 cm. For patients in whom lobectomy is unsuitable, segmentectomy should be recommended for NSCLC > 1 to 2 cm, whereas surgeons could rely on surgical skills and the patient profile to decide between segmentectomy and wedge resection for NSCLC ≤ 1 cm.

Survival and Resected Lymph Node Number During Sublobar Resection for N0 Non-Small Cell Lung Cancer 2 cm or Less

Visceral pleural infiltration (VPI) has been identified as an important risk factor in nonsmall cell lung cancer (NSCLC) for many decades. However, for patients who present with ground glass opacity (GGO), the prognostic value of VPI is still elusive. The authors aimed to investigate whether the VPI is a significant prognostic factor in surgically resected ≤3cm stage I NSCLC, who presented with GGO. Patients with primary NSCLC who underwent surgical resection between December 2009 and December 2018 were collected. Stage I tumors that presented as GGO nodules with a tumor size of less than 3cm were included and divided into two groups based on VPI status (positive and negative). Clinical, pathological, and prognostic data were prospectively collected and retrospectively reviewed. Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics. Overall survival (OS) and recurrence-free survival (RFS) were analyzed using the Cox proportional hazards model and Kaplan-Meier method. A total of 2043 patients were included in this study (VPIs were found in 196 patients). After IPTW weighting, all factors between the two groups were balanced. The median follow-up time was 67.3 months. According to the multivariable Cox models, the VPI was not a significant prognostic factor for OS (HR=2.00, 95% CI: 0.96-4.17; P =0.063), but was significant for RFS (HR=2.00, 95% CI: 1.12-3.55; P =0.019). In subgroup analysis, we found VPI was significant for OS (HR=3.17, 95% CI: 1.09-9.26, P =0.035) and RFS (HR=4.07, 95% CI: 1.76-9.40, P =0.001) in patients with a tumor size >1cm and a consolidation to tumor ratio (CTR) >50%. For patients with a tumor size ≤1cm or a CTR ≤50%, the VPI was not significant. VPI may be a significant risk factor for GGOs in NSCLC patients with a tumor size >1cm and a CTR >50%. Further prospective studies conducted across multicenters with a larger sample size are needed.

BackgroundNo consensus was reached on the surgical procedure for patients with stage I non-small-cell lung cancer (NSCLC) ≤ 2 cm. The aim of this study is to investigate the appropriate surgical procedure for stage I NSCLC ≤2 cm.MethodsPatients with stage I NSCLC ≤2 cm received wedge resection, segmentectomy, lobectomy between January 2004 and December 2015 were identified using the Surveillance, Epidemiology, and End Results (SEER) database. Data were stratified by age, gender, race, side, location, grade, histology, extent of lymphadenectomy. Overall survival (OS) and lung cancer-specific survival (LCSS) were compared among patients received wedge resection, segmentectomy, lobectomy. Univariate analysis and multivariable Cox regression were performed to identify the prognostic factors of OS and LCSS.ResultsA total of 16,511 patients with stage I NSCLC ≤2 cm were included in this study, of whom 2945 patients were classified as stage I NSCLC ≤1 cm. Lobectomy had better OS and LCSS when compared with wedge resection in patients with NSCLC ≤2 cm. Only OS favored lobectomy compared with segmentectomy in stage I NSCLC>1 to 2 cm. Multivariable analysis showed that segmentectomy had similar OS and LCSS compared with lobectomy in patients with stage I NSCLC ≤2 cm. Lymph node dissection (LND) was associated with better OS in patients with NSCLC ≤2 cm and better LCSS in patients with stage I NSCLC>1 to 2 cm.ConclusionsSegmentectomy showed comparable survival compared with lobectomy in patients with stage I NSCLC ≤2 cm. LND can provide more accurate pathological stage, may affect survival, and should be recommended for above patients.

Sublobar resection is considered a standard surgical procedure for early non-small cell lung cancer, although the survival of patients undergoing sublobar resection for clinical T1cN0M0 non-small cell lung cancer remains unclear. This study aimed to compare survival between segmentectomy and wedge resection for clinical T1cN0M0 non-small cell lung cancer. This retrospective study included patients who had undergone curative surgery for cT1cN0M0 stage IA3 non-small cell lung cancer. The overall and recurrence-free survival rates of 91 patients who underwent segmentectomy or wedge resection were compared. Thirty-nine (42.9%) and 52 patients (57.1%) were included in the segmentectomy and wedge resection groups, respectively. The median length of follow-up was 6.0years (95% confidence interval 4.2 - -years) (Kaplan-Meier estimate). The 5year overall survival rates were not significantly different between the segmentectomy and wedge resection groups (67.7% vs 52.0%, P = 0.132). The 5year recurrence-free survival rate was worse in the wedge resection group than in the segmentectomy group (66.6% vs 46.9%, P = 0.047). In univariable analysis, spread through air spaces (hazard ratio, 5.889; 95% confidence interval, 2.357-14.715; P < 0.001) was an important prognostic factor for recurrence-free survival in the wedge resection group. The overall survival of patients who underwent segmentectomy for clinical T1cN0M0 non-small cell lung cancer was not significantly different from that of patients who underwent wedge resection. However, patients with cT1cN0M0 non-small cell lung cancer who underwent wedge resection tended to have a worse recurrence-free survival prognosis than those who underwent segmentectomy.

As the global population ages, the prevalence of early-stage nonsmall cell lung cancer (NSCLC) among octogenarians is rising. This demographic frequently presents with comorbid conditions, diminished cardiopulmonary function, and increased frailty, which elevate the risks associated with standard treatments. While lobectomy combined with lymph node dissection is still considered the gold standard for managing NSCLC, octogenarians are at significantly higher risk of perioperative mortality. Although wedge resection has been suggested as a less invasive option, previous research has insufficiently explored the influence of visceral pleural invasion (VPI) on postoperative outcomes. This study seeks to evaluate whether wedge resection can provide survival outcomes equivalent to those of anatomical resection in this high-risk population. We conducted a retrospective analysis using SEER data from 2010 to 2019, focusing on octogenarians diagnosed with stage I NSCLC and VPI. Propensity score matching, Kaplan-Meier survival analysis, log-rank testing, and Cox multivariate regression were employed to evaluate and compare the outcomes associated with two different surgical techniques. We identified 523 octogenarians with stage I NSCLC and VPI, from a cohort of 1587 patients. In this study cohort, 372 (71.1%) patients received anatomical resection, while 151 (28.9%) patients underwent wedge resection. Following multivariable adjustment and propensity score matching, there were no statistically significant differences in lung cancer-specific survival (CSS; HR 0.99, 95% CI: 0.57-1.73) or overall survival (OS; HR 1.02, 95% CI: 0.68-1.53) observed between the two surgical groups. Additionally, multivariate Cox regression analysis indicated that the choice of surgical approach was not an independent prognostic factor for either CSS (HR 1.29, 95% CI: 0.62-2.69) or OS (HR 1.50, 95% CI: 0.68-1.62). This study demonstrates that wedge resection is a viable surgical option for octogenarians with stage I NSCLC and VPI. Notably, the addition of lymph node dissection to wedge resection significantly enhances survival outcomes compared to wedge resection performed without lymph node dissection.

PurposeThis study aims to investigate the prognostic impact of ground-glass opacity (GGO)-component in early-stage lung cancer patients treated with stereotactic body radiotherapy (SBRT).MethodsFrom January 2013 to December 2022, 239 early-stage lung cancer patients (T1-2N0M0) underwent SBRT. They were categorized into two groups based on the presence of GGO-component: 65 patients in the subsolid group with a consolidation tumor ratio (CTR) between 0.25 and 1 and 174 patients in the solid group with a CTR of 1. Lung cancer-specific survival (LCSS) and progression-free survival (PFS) were analyzed using Cox regression models for both univariate and multivariate analyses to identify prognostic factors. Stabilized inverse probability of treatment weighting (IPTW) was employed for adjusting confounding factors. Recurrence incidence was assessed using competing risk analysis and compared using Gray’s test.ResultsIn the multivariate analysis, female, peripheral location, and subsolid nodules were favorable prognostic factors for LCSS; peripheral location, subsolid nodules, and adjuvant therapy were favorable prognostic factors for PFS. Between the subsolid (n = 65) and solid groups (n = 174), the median LCSS were not reached (p = 0.003), with 3-, 5-, and 9-year LCSS rates of 94.7% versus 80.3%, 90.9% versus 64.1%, 82.7% versus 53.5%, respectively. The median PFS were 72.5 months and 50.5 months (p = 0.030), with 3-, 5-, and 9-year PFS rates of 75.4% versus 61.2%, 56.6% versus 44.9%, 48.6% versus 23.3%, respectively. After stabilized IPTW (n = 240), the median LCSS were not reached (p = 0.024), with 3-, 5-, and 9-year LCSS rates of 94.0% versus 82.4%, 92.2% versus 67.7%, 85.3% versus 58.2%, respectively. The median PFS were 60.2 months and 50.5 months (p = 0.096), with 3-, 5-, and 9-year PFS rates of 73.8% versus 61.0%, 53.5% versus 46.2%, 46.8% versus 22.4%, respectively. The subsolid group had lower rates of locoregional recurrence (LRR) (10.4% vs. 25.9%, p = 0.035) and distant metastasis (DM) (17.1% vs. 37.9%, p = 0.064) compared to the solid group.ConclusionsThe presence of GGO-component in the lesion is an independent prognostic factor for LCSS and PFS. Subsolid nodules treated with SBRT demonstrated better prognosis, with significantly lower rates of local-regional recurrence. We should highlight GGO-component as a practical indicator for risk stratification of SBRT patients to guide treatment decisions.

BackgroundTo investigate the differences in survival between lobectomy and sub-lobar resection for elderly stage I non-small-cell lung cancer (NSCLC) patients using the Surveillance, Epidemiology, and End Results (SEER) registry.MethodThe data of stage IA elderly NSCLC patients (≥ 70 years) with tumors less than or equal to 3 cm in diameter were extracted. Propensity-matched analysis was used. Lung cancer-specific survival (LCSS) was compared among the patients after lobectomy and sub-lobar resection. The proportional hazards model was applied to identify multiple prognostic factors.ResultsA total of 3,504 patients met criteria after propensity score matching (PSM). Although the LCSS was better for lobectomy than for sub-lobar resection in patients with tumors ≤ 3 cm before PSM (p < 0.001), no significant difference in the LCSS was identified between the two treatment groups after PSM (p = 0.191). Multivariate Cox regression showed the elder age, male gender, squamous cell carcinoma (SQC) histology type, poor/undifferentiated grade and a large tumor size were associated with poor LCSS. The subgroup analysis of tumor sizes, histologic types and lymph nodes (LNs) dissection, there were also no significant difference for LCSS between lobectomy and sub-lobar resection. The sub-lobar resection was further divided into segmentectomy or wedge resection, and it demonstrated that no significant differences in LCSS were identified among the treatment subgroups either. Multivariate Cox regression analysis showed that the elder age, poor/undifferentiated grade and a large tumor size were a statistically significant independent factor associated with survival.ConclusionIn terms of LCSS, lobectomy has no significant advantage over sub-lobar resection in elderly patients with stage IA NSCLC if lymph node assessment is performed adequately. The present data may contribute to develop a more suitable surgical treatment strategy for the stage IA elderly NSCLC patients.