Analysis of Individual Patient Data Demonstrates that Sublobar Resection Followed by Adjuvant Chemotherapy has Equivalent Prognosis to Lobectomy in Patients with Stage I NSCLC with Spread through Air Spaces.

[BACKGROUND] Lobectomy (LOB) remains the standard treatment for stage I non-small cell lung cancer (NSCLC), though sublobar resection (SLR) has emerged as a potential alternative with comparable outcomes. Spread through air spaces (STAS) has been confirmed as an independent risk factor after lung cancer surgery. The prognosis differences between LOB and SLR in patients with stage I NSCLC with STAS are controversial.

[PATIENTS AND METHODS] After systematic retrieval across multiple databases, 25 eligible studies involving 14,126 patients were identified. We extracted hazard ratios (HRs) for recurrence-free survival (RFS) and overall survival (OS) comparing lobectomy versus sublobar resection, along with reconstructed individual patient data (IPD) and adjuvant chemotherapy (ACT) records. These datasets were subsequently subjected to meta-analysis with complementary subgroup and sensitivity analyses.

[RESULTS] STAS was confirmed as an independent risk factor (RFS: HR 2.61, 95% CI 2.17-3.14; OS: HR 2.15, 95% CI 1.75-2.63). In subgroup analysis of SLR versus LOB in patients with STAS, the inferior RFS and comparable OS were observed in the SLR group (RFS: HR 1.70, 95% CI 1.16-2.49, n = 3488; OS: HR 1.10, 95% CI 0.83-1.46, n = 3581). Furthermore, ACT following SLR effectively reduced recurrence risk in STAS-positive patients compared with LOB (LOB: RFS: HR 1.03, 95% CI 0.48-2.22; SLR: RFS: HR 0.44, 95% CI 0.23-0.82).

[CONCLUSIONS] Surgical approach significantly impacts survival outcomes in stage I NSCLC patients with STAS. LOB remains the preferred option due to its lower recurrence rate and prolonged survival outcomes; for high-risk patients undergoing SLR, ACT is recommended in the case of postoperative STAS.