Segmentectomy versus lobectomy for small-sized pure solid non-small cell lung cancer.

Abstract

Segmentectomy has been recommended for ground glass opacity (GGO)-dominant small-sized non-small cell lung cancer (NSCLC) or those with GGO component. Pure solid NSCLC is a special sub-type and has an inferior prognosis. Whether segmentectomy could achieve comparable long-term outcomes with lobectomy for pure solid small-sized NSCLC remained controversial. This study aimed to compare the prognosis of segmentectomy and lobectomy for pure solid NSCLC. NSCLC patients with a pure solid nodule (≤2cm) who received segmentectomy or lobectomy between January 2010 and June 2019 were retrospectively screened. Log-rank test, univariable, and multivariable Cox regression analyses were used for prognostic comparison. Further, the propensity score matching analysis was adopted to yield a matched cohort. After screening, 344 pure solid NSCLC patients with a median follow-up time of 56 months were reserved. Among them, 98 patients underwent segmentectomy and the other 246 subjects received lobectomy. The lobectomy group had a larger tumor size, a higher rate of lymph node metastasis than the segmentectomy arm. Generally, patients with segmentectomy had a better disease-free survival (DFS) (p=0.011) and overall survival (OS) (p=0.028) than those with lobectomy. However, the multivariable Cox regression analysis indicated that no significant survival difference existed between segmentectomy and lobectomy after adjusting the potential confounding factors (DFS: hazard ratio [HR],0.72; 95% confidence interval [CI], 0.30-1.77, p=0.476; OS: HR,0.36; 95% CI, 0.08-1.59, p=0.178). Consistently, in the propensity score matched cohort, segmentectomy (n=74) yielded similar DFS (p=0.960) and OS (p=0.320) with lobectomy (n=74). Segmentectomy could achieve comparable oncological outcomes with lobectomy for pure solid small-sized NSCLC.