New Study Shows Sublobar Resection as Effective as Lobectomy for High-Risk Stage I NSCLC

An editorial published in JAMA Oncology shows that sublobar resection can be just as effective as lobectomy for patients with high-risk Stage I non–small cell lung carcinoma (NSCLC). The article, written by Dr Jay M. Lee, highlights significant findings from 2 major phase 3 trials: the Cancer and Leukemia Group B (CALGB140503) and the Japan Clinical Oncology Group (JCOG0802).

The CALGB140503 trial, also known as ALLIANCE, demonstrated that for peripheral NSCLC tumors measuring 2 cm or smaller without lymph node metastasis, sublobar resection (including wedge resection or segmentectomy) was not inferior to lobectomy in terms of disease-free survival (DFS) and overall survival (OS). This trial's findings are pivotal in re-evaluating the surgical approach for early-stage lung cancer patients.

Similarly, the JCOG0802 study, conducted by the West Japan Oncology Group (WJOG4607L), found that segmentectomy (excluding wedge resection) was as effective as lobectomy for peripheral NSCLC tumors of 2 cm or smaller, with a consolidation to tumor ratio greater than 0.5 and no lymph node metastasis. The study concluded that segmentectomy did not compromise relapse-free survival (RFS) or overall survival (OS) compared to lobectomy.

Both studies are considered practice-changing, challenging the long-standing standard of care established by the Lung Cancer Study Group, which previously recommended lobectomy for peripheral tumors 3 cm or smaller without lymph node metastasis. Dr Lee and his colleagues emphasize the importance of these findings in improving the surgical treatment of NSCLC, particularly for high-risk patients. 

Reference
Lee JM. Sublobar resection vs lobectomy for high-risk stage I non-small cell lung carcinoma. JAMA Oncol. doi:10.1001/jamaoncol.2024.2294