Anatomic Lung Resection Is Associated With Improved Survival Compared With Wedge Resection for Stage IA (≤2 cm) NSCLC

Introduction: Given the uncertain generalizability of recent clinical trial data, a comparative effectiveness analysis evaluating the long-term survival of "real world" patients may clarify the role of lobectomy and sublobar resection (segmentectomy or wedge resection) in the treatment of early stage NSCLC. Methods: Adult patients undergoing lung resection for clinical stage IA NSCLC (≤2 cm) between 2012 and 2022 were identified from the Society of Thoracic Surgeons General Thoracic Surgery Database. Long-term vital status was determined by linkage to the National Death Index and Centers for Medicare & Medicaid Services inpatient data. The primary end point was overall survival (OS); secondary end points included lung cancer-specific survival (LCSS). Stabilized inverse probability weighted Cox regression was used to account for selection bias and derive hazard ratios (HRs) with 95% confidence intervals comparing the lobectomy, segmentectomy, and wedge resection cohorts. Results: Overall, 32,340 patients with stage IA NSCLC (19,778 lobectomies [OS = 71.9% (5 y), 44.8% (10 y)], 4279 segmentectomies [OS = 69.6%, 44.2%], and 8283 wedge resections [OS = 66.3%, 41.4%]) were evaluated. After risk adjustment, lobectomy was associated with improved OS and LCSS compared with sublobar resection (HR [OS] = 0.87 [0.83-0.92]; HR [LCSS] = 0.84 [0.73-0.97]). Both lobectomy (HR [OS] = 0.84 [0.80-0.88]; HR [LCSS] = 0.72 [0.56-0.93]) and segmentectomy (HR [OS] = 0.88 [0.81-0.95]; HR [LCSS] = 0.77 [0.66-0.89]) were associated with improved survival compared with wedge resection. No differences in OS or LCSS were observed between lobectomy and segmentectomy. Conclusion: In routine clinical practice, lobectomy and segmentectomy are associated with improved OS and LCSS compared with wedge resection for stage IA NSCLC (≤2 cm). These findings highlight the potential gap between trial efficacy and real-world effectiveness.