Long-term prognosis after sublobar resection for T1a-bN0M0 non-small cell lung cancer: A propensity-score matching study
- VernacularTitle:T1a～bN0M0期非小细胞肺癌亚肺叶切除术远期预后的倾向性评分匹配研究
- Author:
Zhao WANG
1
,
2
,
3
;
Yanqing PAN
1
,
2
,
3
;
Yungang SUN
1
,
2
,
3
;
Feng SHAO
1
,
2
,
3
Author Information
1. Department of Thoracic Surgery, Nanjing Chest Hospital, Nanjing, 210029, P. R. China
2. Department of Thoracic Surgery, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, P. R. China
3. Pulmonary Nodule Diagnosis and Treatment Research Center, Nanjing Medical University, Nanjing, 210029, P. R. China
- Publication Type:Journal Article
- Keywords:
Non-small cell lung cancer;
sublobar resection;
segmentectomy;
wedge resection;
overall survival;
disease-specific survival
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2026;33(06):913-919
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the long-term survival of patients with T1a-bN0M0 non-small cell lung cancer (NSCLC) after sublobar resection. Methods Patients with T1a-bN0M0 NSCLC who underwent sublobar resection from 2004 to 2015 were selected from the Surveillance, Epidemiology, and End Results (SEER) database, and divided into a segmentectomy group and a wedge resection group according to the resection method. After propensity-score matching at a ratio of 1:1, the overall survival (OS) and disease-specific survival (DSS) of patients were analyzed using Cox regression model, log-rank test, and restricted mean survival time (RMST). Results A total of 3262 patients were included in the study, including 1321 males and 1941 females, with a median age of 69.0 years. Among them, 2419 patients were in the wedge resection group and 843 patients were in the segmentectomy group. After matching, 843 pairs of patients were obtained. The results showed that the 10-year DSS rate (68.0% vs. 60.6%, P=0.011) and 10-year OS rate (40.8% vs. 37.0%, P=0.049) of the segmentectomy group were better than those of the wedge resection group, while there was no statistical difference in the 5-year DSS rate (82.9% vs. 79.5%, P=0.112) or 5-year OS rate (68.9% vs. 64.9%, P=0.096). Multivariate Cox regression analysis revealed that male gender [HR=1.54, 95%CI (1.28-1.86), P<0.001] and age [HR=1.02, 95%CI (1.01-1.03), P<0.001] were independent risk factors for DSS, while increased number of regional nodes dissected (RND) [HR=0.98, 95%CI (0.96-1.00), P=0.018] and segmentectomy [HR=0.82, 95%CI (0.68-0.98), P=0.030] served as protective factors. For OS, male gender [HR=1.54, 95%CI (1.35-1.75), P<0.001], age [HR=1.04, 95%CI (1.03-1.04), P<0.001], and histological subtypes of squamous cell carcinoma [HR=1.62, 95%CI (1.41-1.86), P<0.001] or large cell carcinoma [HR=1.64, 95%CI (1.07-2.52), P=0.023] were identified as independent risk factors, whereas increased RND was a protective factor [HR=0.98, 95%CI (0.97-0.99), P=0.002]. Surgical approach was not an independent prognostic factor for OS. Subgroup analysis showed that segmentectomy had a better 10-year OS-RMST in patients with adenocarcinoma (P=0.045), right lower lobe tumor (P=0.014), and tumor diameter ≤1.6 cm (P=0.006). Conclusion Increasing lymph node dissection during sublobar resection may improve prognosis. Compared with wedge resection, segmentectomy may improve the long-term DSS rate of patients with T1a-bN0M0 NSCLC.
