Lung cancer · Extent of resection
Lobar or Sublobar Resection for Peripheral Stage IA Non-Small-Cell Lung Cancer
| Design | Multicentre, non-inferiority, phase 3 trial |
|---|---|
| Treatment | Sublobar resection |
| Control | Lobar resection |
| Population | 697 patients with NSCLC clinically staged T1aN0, tumour 2 cm or less, with intraoperatively confirmed node-negative disease |
| Follow-up | Median 7 years |
| Primary endpoint | Disease-free survival |
| Result | Sublobar resection was non-inferior to lobectomy for disease-free survival (hazard ratio 1.01, 90% CI 0.83 to 1.24). Overall survival was similar (hazard ratio for death 0.95, 95% CI 0.72 to 1.26). Five-year disease-free survival 63.6% versus 64.1%; five-year overall survival 80.3% versus 78.9%. |
| Secondary endpoints | Overall survival, locoregional and systemic recurrence, pulmonary function |
In patients with peripheral NSCLC with a tumor size of 2 cm or less and pathologically confirmed node-negative disease in the hilar and mediastinal lymph nodes, sublobar resection was not inferior to lobectomy with respect to disease-free survival. Overall survival was similar with the two procedures.
The trial authors, in the published abstract
Overturned lobectomy as the automatic operation for small peripheral tumours, after seven years of follow-up. The conditions are strict — 2 cm or less, peripheral, and node-negative confirmed intraoperatively — and lung tissue preserved matters more as screening (NELSON) finds more early cancers in patients who may face a second primary.
Altorki N, Wang X, Kozono D, et al. Lobar or Sublobar Resection for Peripheral Stage IA Non-Small-Cell Lung Cancer. N Engl J Med 2023 Feb 9;388(6):489-498.