Segmentectomy versus lobectomy in non-small-cell lung cancer with pathologically invasive features: a post-hoc supplementary analysis of a multicenter, Phase 3 trial JCOG0802/WJOG4607L
Mené sur 1 106 patients atteints d'un cancer du poumon non à petites cellules de stade IA (durée médiane de suivi : 7,1 ans), cet essai randomisé de phase III évalue l'efficacité, du point de vue de la survie globale, d'une segmentectomie par rapport à une lobectomie
Background: Segmentectomy has become a standard treatment for small-sized peripheral non-small-cell lung cancer (NSCLC). However, its advantages over lobectomy in NSCLC harboring pathologically invasive features remain unclear.
Methods: We conducted a post-hoc supplementary analysis of randomised controlled phase 3 trial JCOG0802/WJOG4607L, in patients with clinical stage IA NSCLC (≤2 cm) harboring one or more of the following pathologically invasive features: lymphatic, vascular, or pleural invasion and lymph node metastasis. The primary outcome was overall survival (OS), and secondary outcomes were relapse-free survival (RFS), cumulative incidence of locoregional relapse, lung cancer-specific death, and death from other causes.
Results: Of the 1,106 participants randomly assigned to the lobectomy or segmentectomy arm, 298 (27%) were included in this analysis: 164 patients were in the lobectomy arm and 134 in the segmentectomy arm. At a median follow-up of 7.1 years (IQR 5.9−8.4), segmentectomy showed a trend toward better OS than lobectomy; hazard ratio (HR) 0.657 (95% CI 0.401–1.077), p=0.0936. The cumulative incidence of death from other causes was significantly reduced in the segmentectomy compared with the lobectomy (HR 0.359 [95% CI 0.143–0.900]). RFS and cumulative incidence of lung cancer-specific death were not significantly different between the two arms, while the cumulative incidence of locoregional relapse was significantly higher in the segmentectomy than in the lobectomy (HR 2.234 [95% CI 1.334–3.741]).
Conclusions: Segmentectomy showed better OS compared with lobectomy even for NSCLC harboring pathologically invasive features. However, the risk of locoregional relapse after segmentectomy should be considered.
Journal of Thoracic Oncology , résumé, 2026