Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 8.
doi: 10.1245/s10434-025-17871-z. Online ahead of print.

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

Jia-Jun Cheng #  1 , Zhang-Yi Dai #  1 , Fu-Qiang Wang  1 , Han-Lu Zhang  1 , Qiang Pu  1 , Yun Wang  2
Affiliations

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

Jia-Jun Cheng et al. Ann Surg Oncol. .

Abstract

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.

Keywords: Adjuvant chemotherapy; Lobectomy; Prognosis; Spread through air spaces; Sublobar resection.

PubMed Disclaimer

Conflict of interest statement

Disclosure: The authors declare they have no conflict of interest. Ethical approval: No ethical approval was required since the data were extracted from already published studies.

Similar articles

See all similar articles

References

    1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49. https://doi.org/10.3322/caac.21660 . - DOI - PubMed
    1. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer lung cancer study group. Ann Thorac Surg. 1995;60(3):615–22. https://doi.org/10.1016/0003-4975(95)00537-u . - DOI - PubMed
    1. Saji H, Okada M, Tsuboi M, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet Lond Engl. 2022;399(10335):1607–17. https://doi.org/10.1016/S0140-6736(21)02333-3 . - DOI
    1. Wolf AS, Richards WG, Jaklitsch MT, et al. Lobectomy versus sublobar resection for small (2 cm or less) non-small cell lung cancers. Ann Thorac Surg. 2011;92(5):1819–23. https://doi.org/10.1016/j.athoracsur.2011.06.099 . - DOI - PubMed
    1. Winckelmans T, Decaluwé H, De Leyn P, Van Raemdonck D. Segmentectomy or lobectomy for early-stage non-small-cell lung cancer: a systematic review and meta-analysis. Eur J Cardiothorac Surg. 2020;57(6):1051–60. https://doi.org/10.1093/ejcts/ezz339 . - DOI - PubMed

LinkOut - more resources