Sublobar resection versus lobectomy in non-small cell lung cancer: a propensity matched analysis

Abstract

Objective: this study analyses long-term results of sublobar resection in daily clinical activity versus the standard procedure (lobectomy).

Method: From a prospective database, patients treated with sublobar resection for NSCLC were identified (2007-2017). None of them had malignant disease in the 5 previous years nor induction treatment. Log-rank test was used to compare overall survival and disease free survival. One-to-one propensity score matching was performed for age, sex, stage, and comorbities to reduce bias selection.

Results: 1214 patients were surgically treated for lung cancer in that period of time. Finally, 52 patients were included in sublobar group with following resections: pulmonary wedge 37(71.2%) cases; anatomic segmentectomy 15(28.8%) cases. Women 4(7.7%); Men 48(92.3%). Mean age: 68.6 y.o. (range 42-86). Pulmonary function test (FEV1 64.9% vs 77.3% p=0.004) and tumoral size (1.9cm vs 3.0cm p<0.001) were lower in the sublobar resection group. PET-TC uptake was higher in lobectomy group (SUVmax 7.6 vs 5.6 p=0.050).

• stage I-A 27 cases (51.9%)

• stage I-B 15 cases (28.8%)

• stage II-A 1 case (1.9%)

• stage II-B 7 cases (13.5%)

• stage III-A 2 cases (3.8%)

Overall survival showed no statistically differences: 90.7 months for sublobar resection group; 91.2 months for lobectomy group (p=0.951). Disease free survival was longer for lobectomy group (93.5 months) than for sublobar group (66.3 months), although with no statistical significant difference (p=0.087).

Conclusion: In selected cases, sublobar resection can reach an overall survival similar to lobectomy. Multicenters studies are needed to confirm these results.