Segmentectomy versus Lobectomy in the United States

Objective To identify whether the results of JCOG0802 could be generalized to U.S. clinical settings. Methods Patients diagnosed with clinical stage IA (< 2 cm) non-small-cell lung cancer (NSCLC) who underwent segmentectomy vs. lobectomy (2004-2017) in the National Cancer Database (NCDB) were identified. Overall survival (OS) of patients in the NCDB was assessed using propensity score-matched analysis. A separate analysis of the SEER database was conducted to evaluate treatment patterns of second primary lung cancers among patients who underwent segmentectomy vs. lobectomy for first primary lung cancer. Results Of the 23,286 patients in the NCDB meeting inclusion criteria, 1,397 (6.0%) underwent segmentectomy and 21,889 (94.0%) underwent lobectomy. In a propensity-score matched analysis of all patients in the study cohort, there were no significant differences in OS between patients undergoing segmentectomy versus lobectomy (5-year OS: 79.9% [95% CI: 76.7% to 82.0%] vs. 81.8% [95% CI: 78.7% to 84.4%], log-rank: P=0.72). In subgroup analyses by tumor grade and histologic subtype, segmentectomy was associated with similar overall survival in all subgroups evaluated. In a propensity score-matched analysis of patients in the SEER database, there were no significant differences in treatment patterns of second primary lung cancers between patients who underwent segmentectomy vs. lobectomy for their first primary lung cancer. Conclusion In this national analysis of U.S. patients diagnosed with stage IA (< 2 cm) NSCLC, there were no significant differences in OS between segmentectomy versus lobectomy in the overall cohort or in subgroup analyses by tumor grade or histologic subtype.