ArticlePloS one2026
Survival following sublobar resection after neoadjuvant therapy for T1N1-2M0 lung cancer.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLobectomy remains the standard surgical approach for resectable non-small cell lung cancer (NSCLC), but sublobar resection is increasingly considered, particularly for small, early-stage tumors. The role of sublobar resection after neoadjuvant therapy is unclear. We compared survival after sublobar resection versus lobectomy among patients with T1N1-2M0 NSCLC treated with neoadjuvant therapy.
methodsUsing the National Cancer Database (2011-2021), we identified patients ≥18 years with clinical stage T1N1-2M0 NSCLC who received neoadjuvant chemotherapy, chemoradiation, or chemoimmunotherapy followed by resection within 8 months. Patients with pneumonectomy, metastases, positive margins were excluded. Patients were grouped by resection type: sublobar (wedge or segmentectomy) vs. lobectomy (including bilobectomy and extended). Survival was assessed via Kaplan-Meier analysis and multivariable Cox regression.
resultsOf 2,257 patients, 148 (6.6%) underwent sublobar resection. Compared to lobectomy, sublobar resection was associated with fewer lymph nodes examined (24% vs. 54% with >10 nodes, p < 0.001) and shorter hospital stays (3.9 vs. 5.3 days, p < 0.001). Stage distribution was similar. One-year survival was comparable for both groups in stage II and III disease. At 5 years, survival was lower for stage III patients undergoing sublobar resection (48.6% vs. 59.9%, p < 0.01), with adjusted analysis confirming worse survival (HR = 1.41, p = 0.013).
conclusionsAmong patients with T1N1-2M0 NSCLC treated with neoadjuvant therapy, sublobar resection was associated with similar short-term but inferior long-term survival compared to lobectomy. Lobectomy remains preferred for patients with adequate reserve, though sublobar resection may be appropriate for select patients.
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