Is sublobar resection equivalent to lobectomy in Black and Hispanic patients with clinical stage IA non-small cell lung cancer?

Objective: The Cancer and Leukemia Group B 140503 and Japan Clinical Oncology Group 0802/West Japan Oncology Group 4607L trials established sublobar resection (SLR) as an acceptable alternative for lobectomy for operable, peripheral stage IA2 ≤2 cm non-small cell lung cancer (NSCLC). However, less than 4% of trial patients were Black or Hispanic. We sought to determine the use of SLR in Black/Hispanic patients and whether outcomes are comparable with those in White patients. Methods: Patients with stage IA2, ≤2 cm NSCLC were identified in the National Cancer Database (2018-2020). The prevalence of SLR was calculated and contrasted using prevalence ratios. Overall survival between SLR and lobectomy was determined in propensity-matched cohorts. Regional node count and pathologic upstaging were analyzed to assess surgical quality. Results: The prevalence of SLR was greatest in White patients (32.1%; 95% CI, 31.4-32.9) and lowest in Hispanic patients (27.5%; 95% CI, 24.0-31.2). A propensity-matched cohort of White patients had no significant difference in OS between SLR and lobectomy (3-year overall survival [OS] 85.0 vs 85.6%; hazard ratio, 1.01; 95% CI, 0.90-1.14, Conclusions: Our analysis suggests that although SLR offers a lung-sparing alternative to lobectomy with comparable outcomes in White non-Hispanic patients, Black patients who undergo this operation are more likely to experience inferior surgical quality and worse survival outcomes. Hispanic patients are less likely to receive SLR.