Background: Lobectomy with mediastinal
lymph node dissection has always been recognized as the standardized treatment for early-stage
non-small-cell lung cancer. However, the feasibility of
segmentectomy performed in stage IB
non-small-cell lung cancer (NSCLC) patients remains controversial. The present study aims to investigate whether the outcome of stage IB NSCLC patients undergoing
segmentectomy was comparable to those who underwent lobectomy. Method: We retrospectively collected data of 11,010 patients with primary stage IB
non-small-cell lung cancer from the Surveillance, Epidemiology, and End Results database. Overall survival (OS) and
lung cancer-specific survival (LCSS) were assessed among patients who were performed lobectomy or
segmentectomy. To further assess the impact of the
surgical procedures on patients with different
tumor sizes, subgroups stratified by
tumor size were analyzed. Results: A total of 11,010 patients who were pathologically confirmed to be stage IB were included, of whom 10,453 received lobectomy and 557 received
segmentectomy. Both univariate and multivariate Cox regression analyses showed that the patients receiving lobectomy had better OS [hazards ratio (HR) = 1.197, 95% confidence interval (CI) (1.066, 1.343), P < 0.001] than those receiving
segmentectomy. However, multivariate analysis showed that there was no significant difference in LCSS between lobectomy and
segmentectomy [HR = 1.172, 95% CI (0.963, 1.427), P = 0.114]. Meanwhile, subgroup analyses showed that lobectomy rather than
segmentectomy was associated with better OS [HR = 1.278, 95% CI (1.075, 1.520) P = 0.006] and LCSS [HR = 1.118, 95% CI (1.005, 1.280), P = 0.047] for patients with a
tumor size (TS) of ≤ 40 and >30 mm, while for patients with a TS of ≤ 30 mm, lobectomy yielded similar OS [TS ≤ 20 mm: HR = 1.068, 95% CI (0.853, 1.336), P = 0.566; TS > 20 mm and ≤ 30 mm: HR = 1.195, 95% CI (0.961, 1.487), P = 0.109] and LCSS [TS ≤ 20 mm: HR = 1.029, 95% CI: (0.682, 1.552), P = 0.893; TS > 20 and ≤ 30 mm: HR = 1.144, 95% CI (0.795, 1.645), P = 0.469] to that of
segmentectomy. Conclusion:
Segmentectomy achieved equivalent OS and LCSS in stage IB NSCLC patients with TS ≤ 30 mm compared with lobectomy. Lobectomy showed better OS and LCSS than
segmentectomy for patients with a TS of >30 and ≤ 40 mm.
Segmentectomy may be acceptable in patients with an older age and a smaller TS.