Sublobar Resection Versus Lobectomy for Small (≤3 cm) NSCLC with Visceral Pleural Invasion: A Propensity-Score-Matched Survival Analysis from a Nationwide Cohort
Journal
Cancers
Journal Volume
17
Journal Issue
12
Start Page
1990
ISSN
2072-6694
Date Issued
2025-06-14
Author(s)
Chen, Chi-Jen
Wei, Chih-Fu
Zheng, Yu-An
Lin, Ching-Chun
Chiang, Chun-Ju
Chen, Pau-Chung
Lee, Wen-Chung
Abstract
Background/Objectives: While sublobar resection (SLR) is accepted for selected small, early non-small-cell lung cancers (NSCLCs), its efficacy for tumors with visceral pleural invasion (VPI) remains debated. This study aimed to compare lung-cancer-specific survival (LCSS) between SLR and lobectomy in pT2a (tumor ≤ 3 cm with VPI) N0M0 NSCLCs from a nationwide population-based database. Methods: This retrospective study utilized Taiwan Cancer Registry data from 2011 to 2018, selecting patients with pT2a (tumor ≤ 3 cm with VPI) N0M0 NSCLC that underwent SLR or lobectomy, with specific exclusion criteria. Propensity score matching (1:1) was performed using a greedy algorithm with a 0.01 caliper width. LCSS was compared using Kaplan-Meier analysis with log-rank tests and Cox proportional hazards models before and after matching. Results: In the 2460-patient cohort (624 SLR, 1836 lobectomy) before matching, lobectomy was associated with significantly better overall (p = 0.01) and PL1 VPI subgroup (p = 0.009) LCSS. In the matched cohort (523 pairs), no significant difference in LCSS was observed between SLR and lobectomy, either overall (p = 0.21) or when stratified by PL1 (p = 0.11) or PL2 (p = 0.94) status. Multivariate Cox analysis in the matched cohort confirmed no significant association between surgery type and LCSS (adjusted HR 0.75, 95% CI 0.52-1.08, p = 0.124), but older age (>75 years), PL2 VPI, and lymphovascular invasion were independent predictors of worse LCSS (all p < 0.001). Conclusions: This large population-based study, after rigorous adjustment for confounders, found that SLR and lobectomy provided comparable LCSS. SLR may be an alternative for selected patients, but prospective validation is recommended.
Subjects
early lung cancer
lobectomy
non-small-cell lung cancer (NSCLC)
propensity score matching
sublobar resection
visceral pleural invasion (VPI)
Publisher
MDPI AG
Type
journal article