Abstract
BACKGROUND: The optimal surgical extent for clinical T1c solid-dominant non-small cell lung cancer (NSCLC) remains debated. This study aimed to compare the recurrence-free survival (RFS) and overall survival (OS) between segmentectomy and lobectomy in patients with clinical T1c solid-dominant NSCLC. METHODS: We retrospectively analyzed 888 patients with clinical T1c solid-dominant NSCLC [tumor diameter: 2-3 cm; consolidation-to-tumor ratio (CTR) >0.5] who underwent segmentectomy of the dominant pulmonary segment or lobectomy. Clinical characteristics, 5-year RFS, and 5-year OS were evaluated. Propensity score matching (PSM, 1:1) and subgroup Cox regression models were employed to adjust for confounders. RESULTS: Of the 888 eligible cases, segmentectomy and lobectomy were performed in 55 and 833 patients, respectively. The difference in the 5-year OS between segmentectomy and lobectomy was found to be statistically significant (91.7% vs. 84.3%, P=0.02), which was also showed in the propensity score analysis (91.7% vs. 90.0%; P=0.08), with a median follow-up time of 46 months. The 5-year RFS did differ significantly between segmentectomy and lobectomy (89.46% vs. 71.50%; P=0.02), but it shown no difference in the propensity score analysis (89.46% vs. 81.5%; P=0.26). CONCLUSIONS: The results indicate that segmentectomy of dominant pulmonary segment is superior to lobectomy in terms of OS for solid-dominant NSCLC cases with a tumor diameter between 2 and 3 cm.