Lobectomy Versus Segmentectomy in Patients with T1N2 Non-Small Cell Lung Cancer: An Analysis of the National Cancer Database

Objective Assess survival outcomes for patients with stage IIIA (T1N2M0) non-small cell lung cancer (NSCLC) using the National Cancer Database (NCDB). Methods Patients with T1N2M0 NSCLC undergoing lobectomy or segmentectomy were identified in the NCDB from 2004-2019. Patient characteristics were compared using Chi-squared and Fisher exact tests. Overall survival was evaluated using the Kaplan-Meier method and the Cox proportional hazard analysis adjusting for type of resection, age, sex, margin positivity, Charlson comorbidity index, number of lymph nodes examined, number of positive lymph nodes, and tumor size. Results 2,883 patients with T1N2 NSCLC undergoing segmentectomy or lobectomy were identified. The majority (96.5%) of patients received lobectomy and 100 (3.5%) patients received segmentectomy. Patients undergoing segmentectomy were older (p=0.001) and had tumors in the lower lobe of the lung (p=0.001) vs patients undergoing lobectomy. Fewer patients who received segmentectomy underwent radiation (p=0.015) and neoadjuvant chemotherapy (p=0.041). Fewer patients undergoing segmentectomy had >10 lymph nodes examined and >5 positive nodes compared to patients receiving lobectomy (both p<0.001). While 30-day readmission rates were similar (p=0.27), 30-day mortality was lower in the segmentectomy cohort (p=0.047). There was a significantly lower risk of death among patients undergoing lobectomy vs segmentectomy (hazard ratio 0.96 (95% confidence interval 0.94-0.98), p=0.001). Conclusions In this NCDB analysis, lobectomy was more commonly performed for T1N2 NSCLC compared to segmentectomy. Lobectomy offered a significant survival advantage over segmentectomy, even when adjusting for risk factors. Thus, these findings suggest that lobectomy may be a superior resection of choice for patients with T1N2 disease.