Lobectomy and sublobar resection produce similar outcomes in patients with T1aN0 non-small cell lung cancer (NSCLC), according to a phase 3 trial published in The New England Journal of Medicine.1
Researchers found similar rates of recurrence, disease-free survival (DFS), and overall survival (OS) whether patients underwent sublobar resection or lobectomy.
The researchers conducted this phase 3 study (ClinicalTrials.gov Identifier: NCT00499330) in 697 patients with T1aN0 NSCLC. The median age at baseline was 67.9 years (range, 37.8-89.7 years), 90% of patients were White, 57.4% were women, and 63.7% had adenocarcinoma.
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The patients were randomly assigned to undergo sublobar resection (n=340) or lobectomy (n=357). In the sublobar resection arm, 59.1% of patients underwent wedge resection, and 37.9% underwent an anatomical segmental resection.
At a median follow-up of 7 years, DFS with sublobar resection was noninferior to DFS with lobectomy (hazard ratio [HR], 1.01; 90% CI, 0.83-1.24). The 5-year DFS rate was 63.6% after sublobar resection and 64.1% after lobectomy.
OS results were similar between the treatment arms (HR, 0.95; 95% CI, 0.72-1.26). The 5-year OS rate was 80.3% after sublobar resection and 78.9% after lobectomy.
Rates of recurrence were similar between the arms as well. The overall recurrence rate was 30.4% after sublobar resection and 29.3% after lobectomy. The rate of locoregional recurrence was 13.4% and 10.0%, respectively. The rate of distant recurrence was 15.2% and 16.8%, respectively.
At 6 months after surgery, the reduction from baseline in the percentage of predicted forced expiratory volume in 1 second was greater after lobectomy than after sublobar resection (−6.0 and −4.0, respectively). The reduction in the percentage of predicted forced vital capacity was greater after lobectomy as well (−5.0 vs −3.0).
The researchers concluded that these results, particularly when considered alongside results from the JCOG0802 trial,2 “affirm that sublobar resection . . . is an effective management approach for this subgroup of patients with NSCLC.”
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
References
1. Altorki N, Wang X, Kozono D, et al. Lobar or sublobar resection for peripheral stage IA non–small-cell lung cancer. N Engl J Med. Published online February 9, 2023. doi:10.1056/NEJMoa2212083
2. Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet. 2022;399:1607-17. doi:10.1016/S0140-6736(21)02333-3
