Better survival with lobectomy versus sublobar resection in patients with hypermetabolic c-stage IA lung cancer on positron emission tomography/computed tomography

OBJECTIVES The clinical trial showed that sublobar resection was not inferior to lobectomy in terms of disease-free survival in patients with peripherally located non-small-cell lung cancer <= 2 cm. However, it is not clear whether sublobar resection is indicated for all types of c-stage IA lung cancer. The purpose of this study was to clarify whether sublobar resection is indicated for c-stage IA hypermetabolic lung cancer. METHODS Patients with c-stage IA lung cancer who underwent F-18 fluorodeoxyglucose positron emission tomography/computed tomography and lobectomy or sublobar resection were assessed. Of these, patients who had a maximum standardized uptake value >= 3.0 on positron emission tomography/computed tomography were evaluated. We compared survival rates after lobectomy versus sublobar resection. Propensity score matching was performed to balance patient characteristics between groups. RESULTS Between April 2004 and March 2023, 723 patients underwent lobectomy or sublobar resection and had a maximum standardized uptake value >= 3.0 on positron emission tomography/computed tomography. Lobectomy and sublobar resection were performed in 532 (73.6%) and 191 (26.4%) patients, respectively. Both the 5-year overall and disease-free survival rates were worse after sublobar resection compared with lobectomy (62.3% vs 79.9% and 53.9% vs 70.3%, respectively). After propensity score matching, the 5-year overall and disease-free survival rates remained worse after sublobar resection compared with lobectomy (60.7% vs 75.2% and 51.6% vs 67.7%, respectively). CONCLUSIONS Patients with c-stage IA hypermetabolic lung cancer with standardized uptake value >= 3.0 on positron emission tomography/computed tomography had a worse prognosis after sublobar resection than after lobectomy.