# Segmentectomy versus lobectomy in younger patients with early-stage non-small cell lung cancer

## TL;DR

Segmentectomy is as effective as lobectomy for younger patients with early-stage lung cancer, suggesting it can be a valid alternative regardless of age.

## Contribution

The study demonstrates that segmentectomy is a viable surgical option for younger patients with early-stage NSCLC, challenging prior concerns about its efficacy in this group.

## Key findings

- Survival outcomes were comparable between segmentectomy and lobectomy in younger NSCLC patients.
- Propensity score matching confirmed no significant difference in overall or recurrence-free survival between the two procedures.
- Restricted mean survival time analysis showed similar long-term outcomes for both surgical approaches.

## Abstract

Despite clinical trials supporting the efficacy of segmentectomy for early-stage non-small cell lung cancer (NSCLC), a previous report indicated its limited efficacy in younger patients, raising concerns about its indication.

Patients aged <70 years with radiologically solid-dominant clinical stage IA NSCLC ≤2 cm who underwent lobectomy or segmentectomy at three institutions between 2010 and 2017 were enrolled. Propensity scores were estimated to adjust for confounding variables (age, sex, smoking history, tumour location, size, ground-glass opacity, maximum standardized uptake value and histological type). To elucidate the prognostic impact of surgical indications in the late postoperative phase, restricted mean survival time (RMST) from 0 to 5 and 8 years was also determined.

Overall, 388 patients with a median age of 63 years were enrolled. Overall survival (OS) (hazard ratio [HR], 0.447; 95% confidence interval [CI], 0.152–1.316) and recurrence-free survival (RFS) (HR, 0.638; 95% CI, 0.335–1.216) did not differ significantly between the segmentectomy (n = 114) and lobectomy groups (n = 274). In the propensity score matching of 100 pairs, OS (HR, 0.577; 95% CI, 0.162–2.056) and RFS (HR, 0.945; 95% CI, 0.408–2.191) were comparable between the segmentectomy and lobectomy groups. Regarding OS in the segmentectomy and lobectomy groups, the 5- and 8-year RMST were 4.95 years versus 4.92 years (difference: 0.02 years; 95% CI, −0.09–0.13; P = 0.699) and 7.82 years versus 7.69 years (difference: 0.12 years; 95% CI, −0.17–0.42; P = 0.420), respectively.

Segmentectomy is a viable option for younger patients with early-stage NSCLC, suggesting that indications for segmentectomy need not vary by age.

Lobectomy has been the recommended surgical procedure for early-stage non-small cell lung cancer (NSCLC) since a randomized trial was published by the Lung Cancer Study Group [1].