Conditional Survival of Patients With Early-Stage Non-Small Cell Lung Cancer Who Undergo Lobectomy, Segmentectomy, or Wedge Resection Using the NCDB

Background and Objectives: Randomized clinical trials have shown that sub-lobar resection for clinical stage (cStage) IA non-small cell lung cancer (NSCLC) is non-inferior to lobar resection. We evaluated traditional and conditional survival differences between lobectomy, wedge resection, and segmentectomy in patients with cStage IA NSCLC. Methods: The National Cancer Database (2004–2019) was queried for patients with cStage IA (≤ 2 cm) NSCLC who underwent upfront lobectomy, segmentectomy, or wedge resection. Patients were stratified by extent of resection. Propensity-matched traditional (TSA) and conditional (CSA) survival analyses were performed. Propensity score included age, gender, histology, tumor grade, and Charlson-Deyo score. Number of lymph nodes (LN) harvested was also compared between groups. Results: There were 46 395 patients who met the inclusion criteria, of whom 32 599 (70.3%) received lobectomy, 11 181 (24.1%) wedge resection, and 2615 (5.6%) segmentectomy. Following propensity matching, all groups contained 2615 patients. In the TSA, segmentectomy (hazard ratio [HR]: 1.19, 95% confidence interval [CI]: 1.08–1.32) and wedge resection (HR: 1.41, CI: 1.28–1.56) were associated with worse 5-year survival. This remained significant in CSA at 3- and 5-years post-resection in patients who underwent segmentectomy (HR: 1.24, CI: 1.08–1.43 and HR: 1.23, CI: 1.02–1.49, respectively) and wedge resection (HR: 1.42, CI: 1.24–1.63 and HR: 1.33, CI: 1.11–1.59, respectively). Wedge resection and segmentectomy were associated with a lower number of harvested LN (median = 4 and 6, respectively) compared to lobectomy (8, p < 0.001). Conclusion: Analysis of real-world data suggests that lobectomy is associated with improved traditional and conditional 5-year survival as well as LN harvest.