Intentional sublobar resection versus lobectomy for non-small cell lung cancer ≤3 cm, including solid ground-glass nodules: a real-world study.

BACKGROUND: Surgical resection remains the cornerstone of treatment for early-stage non-small cell lung cancer (NSCLC). However, the survival benefits of different surgical approaches in patients with a tumor size ≤3 cm (T1 stage) remain controversial. This study aimed to compare the survival outcomes of patients with NSCLC and a tumor size ≤3 cm who underwent sublobar resection or lobectomy. METHODS: This real-world study was conducted at one of the largest thoracic surgery centers in eastern China. Consecutive patients who underwent intentional sublobar resection or lobectomy for NSCLC with a tumor size ≤3 cm and a consolidation-to-tumor ratio (CTR) ≤1 from January 2014 to December 2015 were enrolled in the study. Data were collected retrospectively. Propensity score matching (PSM) was used to balance the baseline characteristics. The primary endpoints included overall survival (OS) and recurrence-free survival (RFS). The secondary endpoints included perioperative outcomes and postoperative complications. RESULTS: A total of 685 patients were enrolled in the study, with 229 matched pairs included after PSM. Compared with sublobar resection, lobectomy was associated with fewer postoperative drainage days (3.72±1.33 vs. 4.50±2.53 days, P=0.002) and lower postoperative drainage volume (572.88±304.18 vs. 712.07±551.39 mL, P=0.005). However, no significant differences were observed between the two groups in terms of 10-year OS [hazard ratio (HR) =0.87, 95% confidence interval (CI): 0.32-2.41, P=0.79] or 10-year RFS (HR =0.99, 95% CI: 0.45-2.21, P=0.99). Similarly, the multivariate Cox model revealed no significant differences between the two groups in terms of 10-year OS (HR =1.05, 95% CI: 0.48-3.76, P=0.58) or 10-year RFS (HR =1.05, 95% CI: 0.47-2.36, P=0.89). CONCLUSIONS: For NSCLC tumors ≤3 cm, including solid ground-glass opacities (GGOs), sublobar resection represents an appropriate surgical option, and that prospective validation or careful patient selection remains necessary.