T≤2cmN0 non-small cell lung cancer with visible pleural retraction will benefit from lobectomy rather than sublobar resection: An inverse probability of treatment weighting study.

[INTRODUCTION] Lobectomy has long been considered as the gold standard for the treatment of early-stage non-small cell lung cancer (NSCLC). However, the efficacy of sublobar resection has been confirmed in some patients. Pleural retraction was observed intraoperatively in some patients, and there is no evidence whether sublobar resection can achieve similar results to lobectomy in these patients. We therefore conducted this retrospective study to compare the survival of lobectomy and sublobar resection in cT1 (≤2 cm) N0M0 NSCLC with visible pleural retraction.

[MATERIALS AND METHODS] We retrospectively included 987 T ≤ 2cmN0 NSCLC patients who underwent radical surgery for lung cancer with visible pleural retraction. Inverse probability of treatment weighting was used to balance the differences of baseline characteristics. We compared the recurrence-free survival (RFS) and overall survival (OS) between those who underwent lobectomy and sublobar resection. Subgroup analysis was also performed.

[RESULTS] Sublobar resection has worse RFS compared to lobectomy (HR = 1.97, 95 %CI [1.13-3.42], p = 0.02). Patients with solid nodules who received sublobar resection showed both shorter RFS and OS (HR = 2.73, 95 %CI [1.47-5.05], p < 0.01 and HR = 2.29, 95 %CI [1.08-4.86], p = 0.03, respectively).

[CONCLUSIONS] For T ≤ 2 cm N0 NSCLC with pleural retraction, lobectomy is associated with improved recurrence free survival over sublobar resection.