Is Sublobar Resection Optimal for Peripheral Nodules ≤2 cm with Micropapillary or Solid Histologic Components?

Abstract

The optimal extent of resection for small peripheral nonmucinous invasive lung adenocarcinoma with high-risk histologic features remains uncertain. Although sublobar resection is increasingly accepted for selected early-stage tumors, its adequacy for nonmucinous invasive lung adenocarcinoma harboring micropapillary or solid histologic components are not well defined. We conducted a retrospective single-center cohort study of 501 patients with peripheral nonmucinous invasive lung adenocarcinoma ≤2 cm (pN0M0) containing micropapillary or solid histologic components who underwent lobectomy or sublobar resection between 2018 and 2020. Recurrence-free survival and lung cancer-specific survival were analyzed using Kaplan-Meier methods and Cox proportional hazards models. Propensity-score matching was performed as a sensitivity analysis to adjust for baseline differences. Lobectomy was associated with higher 5-year recurrence-free survival and lung cancer-specific survival compared with sublobar resection (log-rank P < .001). These associations remained consistent after propensity-score matching. In matched analyses, consolidation-to-tumor ratio >0.5, visceral pleural invasion, wedge resection, and segmentectomy were independently associated with worse lung cancer-specific survival and recurrence-free survival compared with lobectomy. In this single-center retrospective cohort, lobectomy was associated with more favorable outcomes than sublobar resection among ≤ 2 cm peripheral nonmucinous invasive lung adenocarcinoma harboring micropapillary or solid histology components. However, these findings are hypothesis-generating and require prospective validation.