Sublobar Resection in Early Non-Small Cell Lung Cancer With Epidermal Growth Factor Receptor Mutant

Takahiro Mimae; Yoshihiro Miyata; Norifumi Tsubokawa; Yoshihisa Shimada; Takuya Nagashima; Hiroyuki Ito; Norihiko Ikeda; Morihito Okada

doi:10.1016/j.athoracsur.2023.12.009

Sublobar Resection in Early Non-Small Cell Lung Cancer With Epidermal Growth Factor Receptor Mutant

Ann Thorac Surg. 2024 Jan 9:S0003-4975(24)00002-X. doi: 10.1016/j.athoracsur.2023.12.009. Online ahead of print.

Authors

Takahiro Mimae¹, Yoshihiro Miyata¹, Norifumi Tsubokawa¹, Yoshihisa Shimada², Takuya Nagashima³, Hiroyuki Ito³, Norihiko Ikeda², Morihito Okada⁴

Affiliations

¹ Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan.
² Department of Surgery, Tokyo Medical University, Tokyo, Japan.
³ Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan.
⁴ Department of Surgical Oncology, Hiroshima University, Hiroshima, Japan. Electronic address: morihit01217@hiroshima-u.ac.jp.

PMID: 38199462
DOI: 10.1016/j.athoracsur.2023.12.009

Abstract

Background: Lobectomy is a standard surgical procedure for peripherally located early-stage non-small cell lung cancers (NSCLCs) measuring 2 to 4 cm. However, it is unclear whether sublobar resections, such as wedge resection and segmentectomy, are effective in treating tumors with driver mutations in the epidermal growth factor receptor (EGFR).

Methods: We analyzed the clinicopathologic findings and surgical outcomes of 1395 patients with radiologically solid-dominant NSCLC measuring 2 to 4 cm, without clinical lymph node involvement, who underwent complete resection between 2010 and 2020. The patients, who underwent sublobar resections (n = 231) or lobectomy (n = 1164), were categorized by their EGFR mutation status and the surgical procedures performed. The follow-up was conducted for a median of 45.3 months.

Results: The 5-year overall survival (OS) rates after sublobar resections (n = 39) were comparable to those after lobectomy (n = 359) in patients with EGFR mutation-positive tumors (80.5% [95% CI, 51.3%-93.2%] vs 88.8% [95% CI, 84.1%-92.1%], respectively; P = .16). Multivariable Cox regression analysis of OS revealed that the surgical procedure was an independent prognostic predictor in the entire cohort (hazard ratio, 0.6; 95% CI, 0.4-1.0; P = .028), but it was not an independent prognostic predictor in patients with EGFR-mutated tumors (hazard ratio, 0.6; 95% CI, 0.2-1.7; P = .32).

Conclusions: Sublobar resection with a secure surgical margin could be a viable option for appropriately selected patients with peripheral early-stage NSCLC tumors measuring 2 to 4 cm and harboring EGFR mutations, because it provides comparable OS to that of lobectomy.