Oncologic outcomes of segmentectomy versus lobectomy for clinical T1c radiological pure-solid non-small cell lung cancer.

Abstract

We aimed to compare the outcomes of segmentectomy with those of lobectomy in T1c (>2-3 cm) radiological pure-solid non-small cell lung cancer detected on thin-section computed tomography. This retrospective review compared the survival outcomes, causes of death, and recurrence patterns between the segmentectomy and lobectomy in patients with c-T1cN0M0 radiological pure-solid non-small cell lung cancer. Multivariable analysis was performed to control for confounders of survival. The overall survival and recurrence-free survival were analyzed using the Kaplan-Meier method. Differences in cumulative incidence of recurrence between groups were assessed using the methods of Gray. Of the 426 patients, lobectomy was performed in 381 patients and segmentectomy in 45 patients. Nodal metastasis was noted in 104 (24.4%) patients. Multivariable analysis revealed that lobectomy was an independent prognosticator of better OS (HR 0.596, 95% CI 0.366-0.969, p = 0.037). Lobectomy arm showed favourable 5-year overall survival and recurrence-free survival (overall survival: 72.9% vs 59.7%, log-rank test p = 0.007; recurrence-free survival: 64.4% vs 48.7%, p = 0.034) (median follow-up: 53 months). Approximately 14% of the patients in the lobectomy group and 27% in the segmentectomy group died of lung cancer. Furthermore, 5-year cumulative incidence of loco-regional recurrence rate was significantly higher in the segmentectomy group (35.5% vs 15.8%, p < 0.001). In T1c radiological pure-solid non-small cell lung cancer, segmentectomy was significantly associated with worse survival and insufficient loco-regional cancer control. Lobectomy remains the standard surgical treatment; meanwhile, segmentectomy should be applied with great caution.