Kazuki Takada, Takamasa Koga, Kotaro Nomura, Taichi Matsubara, Takamitsu Hayakawa, Ryo Fujikawa, Akira Hamada, Kosuke Fujino, Shinya Katsumata, Hikaru Watanabe, Jun Suzuki, Fumihiko Kinoshita, Naoki Haratake, Miyuki Abe, Shinkichi Takamori, Shinya Tane, Hironobu Hoshino, Hiroyuki Tsuchida, Satoshi Muto, Makoto Endo, Tomoyoshi Takenaka, Tomoharu Yoshizumi, Mototsugu Shimokawa, Junichi Soh, Yasuhisa Ohde
Segmentectomy was not associated with worse oncologic outcomes or increased locoregional failure compared with lobectomy among highly selected patients with centrally located small-sized NSCLC. However, because the segmentectomy cohort was very small, these findings should be interpreted cautiously and require validation in larger prospective studies.
BACKGROUND: The oncologic appropriateness of segmentectomy for centrally located small-sized non-small-cell lung cancer (NSCLC) remains unclear. This study evaluated the outcomes of segmentectomy compared with lobectomy for centrally located clinical stage IA NSCLC.
METHODS: This retrospective multicenter cohort study used the CReGYT-02 database from 17 Japanese institutions. Patients with clinical stage IA NSCLC (8th edition), tumor ≤3 cm, and consolidation-to-tumor ratio > 0.5 who underwent segmentectomy or lobectomy between 2012 and 2016 were included. Tumors located in the outer one-third of the lung parenchyma were excluded. Outcomes included recurrence-free survival, overall survival, recurrence patterns, and performance status and treatment at recurrence or diagnosis of other cancers. Kaplan-Meier analysis and Cox proportional hazards models were performed before and after inverse probability of treatment weighting.
RESULTS: Among 479 eligible patients, 26 underwent segmentectomy and 453 lobectomy. After inverse probability of treatment weighting, segmentectomy was not associated with inferior recurrence-free survival (hazard ratio 0.71; 95% confidence interval 0.31-1.67) or overall survival (hazard ratio 1.12; 95% confidence interval 0.46-2.70). Recurrence occurred in 7.7% after segmentectomy and 21.0% after lobectomy; no locoregional recurrences occurred after segmentectomy. All patients in the segmentectomy group maintained performance status 0-1 and received treatment at recurrence or diagnosis of other cancers.
CONCLUSIONS: Segmentectomy was not associated with worse oncologic outcomes or increased locoregional failure compared with lobectomy among highly selected patients with centrally located small-sized NSCLC. However, because the segmentectomy cohort was very small, these findings should be interpreted cautiously and require validation in larger prospective studies.