Abstract
BACKGROUND: Sublobar resection (SLR), which includes wedge resection (WR) and segmental resection (SR), is often considered a compromised procedure for non-small cell lung cancer (NSCLC) patients who have limited pulmonary reserve or other conditions that cannot tolerate lobectomy. This study intends to evaluate and compare the results of WR and SR on overall survival (OS) in patients undergoing compromised SLR. METHODS: Data from the Surveillance, Epidemiology, and End Results (SEER) database was analyzed, identifing 2,047 patients with pathological stage (pStage) IB-IIIB NSCLC who underwent compromised SLR, including WR and SR. The two treatment groups' potential baseline differences were balanced using propensity score matching (PSM). Univariate and multivariate analyses were conducted to determine the impact of procedures on OS before PSM. Kaplan-Meier (KM) analysis calculated survival curves and compared OS across groups before and after PSM. Subgroup analysis investigated the influence of surgical procedures on OS within specific patient subgroups after PSM. Additionally, a sensitivity analysis focusing on patients with T1 and T2 stages was performed after PSM to validate the robustness of the results. RESULTS: Overall, 421 patients (20.57%) underwent SR. In univariate analysis, SR was associated with improved OS as compared to WR (HR = 0.85; 95% CI: 0.75-0.97; P = 0.02). Nevertheless, the association did not last in the multivariate analysis (HR = 0.94; 95% CI: 0.82-1.07; P = 0.32). Following PSM, KM analysis also revealed no significant difference in OS (P = 0.21). A subgroup analysis revealed that SR provided a marginal improvement in OS for patients under the age of 60. However, this impact was only borderline statistically significant (HR = 0.49; 95% CI: 0.23-1.03; P = 0.059), and no relevant link was observed in other groups. Additionally, a sensitivity analysis demonstrated no significant association between SR and OS (HR = 0.91; 95% CI: 0.73-1.13; P = 0.39). CONCLUSIONS: The benefit of SR over WR in compromised SLR for NSCLC patients may be limited. Further studies are necessary to clarify the optimal surgical approach for different patient subgroups.