Segmentectomy versus lobectomy in the United States: Outcomes after resection for first primary lung cancer and treatment patterns for second primary lung cancers

The study objective was to identify whether the results of JCOG0802 could be generalized to US clinical settings. Patients diagnosed with clinical stage IA (≤2 cm) non–small cell lung cancer who underwent segmentectomy versus lobectomy (2004-2017) in the National Cancer Database were identified. Overall survival of patients in the National Cancer Database was assessed using propensity score–matched analysis. A separate analysis of the Surveillance Epidemiology End Results database was conducted to evaluate treatment patterns of second primary lung cancers among patients who underwent segmentectomy versus lobectomy for a first primary lung cancer. Of the 23,286 patients in the National Cancer Database meeting inclusion criteria, 1397 (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 overall survival between patients undergoing segmentectomy versus lobectomy (5-year overall survival: 79.9% [95% CI, 76.7%-82.0%] vs 81.8% [95% CI, 78.7%-84.4%], log-rank: P = .72). In subgroup analyses by tumor grade and histologic subtype, segmentectomy was associated with similar overall survival compared with lobectomy in all subgroups evaluated. In a propensity score–matched analysis of patients in the Surveillance Epidemiology End Results database, there were no significant differences in treatment patterns of second primary lung cancers between patients who underwent segmentectomy and patients who underwent lobectomy for their first primary lung cancer. In this national analysis of US patients diagnosed with stage IA (≤2 cm) non–small cell lung cancer, there were no significant differences in overall survival between segmentectomy and lobectomy in the overall cohort or in subgroup analyses by tumor grade or histologic subtype. Summary of the present study. In a propensity score–matched analysis of patients undergoing segmentectomy versus lobectomy in the NCDB, there were no significant differences in OS between the 2 groups. These data suggest that the superiority of segmentectomy as reported in JCOG0802 is not generalizable to a large US cohort of patients diagnosed with stage IA (≤2 cm) peripheral NSCLC, but do support equivalence, or noninferiority, of segmentectomy. [Display omitted]