European Analysis of Patients with Early-Stage Lung Adenocarcinoma and Invasive Pathological Features Who Underwent Lobectomy versus Segmentectomy

OBJECTIVES: Evaluate impact of common pathologic features, single or in combination, in patients with early-stage lung adenocarcinoma, according to lung resection extent. METHODS: Retrospective multicentric cohort study including patients with cT1a-bN0M0 lung adenocarcinoma and with at least: visceral pleural invasion (VPI) under surface (PL1) or up to surface (PL2), lymphovascular invasion (LVI), spread through airspace (STAS), necrosis, or neural invasion, who underwent lobectomy or segmentectomy with systematic lymph nodal dissection (SND) from 2015-2021 in 10 European centers. Overall survival (OS), disease-free survival (DFS) and lung cancer specific death (LCSD) between both groups were assessed before and after stabilized inverse probability of treatment-weighting (IPTW)-matching. Risk factors for oncologic outcomes were analyzed using parsimonious model Cox proportional hazard regression in entire and multiple features datasets. Kaplan Meir and cumulative incidence function assessed outcome. Log-rank and Gray' tests compared the groups. Linearized risk assessed recurrences. RESULTS: Of 1703 patients with cT1a-bN0M0 lung adenocarcinoma, 530 had at least one poor pathological feature and 130 had multiple features. For the 530 patients, 5-year OS lobectomy 83.0%, segmentectomy 89.4%, p=0.2; 5-year DFS lobectomy 78.1%, segmentectomy 83.8%, p=0.06; and 5-year LCSD lobectomy 8.9%, segmentectomy 7.2%, p=0.6 were similar. It was the same in matched cohort. In multivariable analysis, no poor pathological feature impacted outcome more than others. Multiple poor features were not associated with any clinical, pathological trait, but impacted OS (HR:3.24, p=0.002). Locoregional recurrence (linearized risk: lobectomy 0.083, segmentectomy 0.086) was similar in matched entire dataset. CONCLUSION: Segmentectomy with SND dissection can be indicated in patients with stage IA1-2 lung adenocarcinoma suspected to have poor pathological features. Multiple factors were not predictable but impacted OS.