Effects of lobectomy versus sub-lobar resection on the survival in adults with stage IA left upper lobe non-small cell lung cancer: a retrospective cohort study based on the SEER database

Introduction: To compare the survival after lobectomy (LR) and sub-lobar resection (SLR) of left upper lobe (LUL) among non-small cell lung cancer (NSCLC) patients with stage IA. Methods: This retrospective cohort research analyzed public data collected by the Surveillance, Epidemiology, and End Results (SEER) database. Tumor characteristics were determined based on the International Classification of Diseases for Oncology, 3rd edition (ICD-O-3). Propensity score matching (PSM) analysis was performed with a ratio of 1:1. Univariate and multivariable Cox proportional regression analyses were used to assess the effects of LR and SLR on the survival of the patients, with hazard ratios (HRs) and 95% confidence intervals (95%CIs). The effects were further evaluated by different subgroups of age, gender, tumor grades, histologic types, T stages. Results: Of the total 2,649 patients, 1,907 underwent the LR and 742 received SLR. Totally 998 patients died at the end of the follow-up. The median survival time of all patients were 66 (49, 87) months. After adjusting the age, gender, race, tumor grade, histologic type, T stage, examined lymph nodes, radiation, and chemotherapy, NSCLC patients with stage IA who received SLR had higher odds of death in comparison with these patients who received LR (HR=1.424, 95%CI: 1.227-1.652). After PSM, SLR was associated with higher odds of death in the patients (HR=1.35, 95%CI: 1.10-1.66). Similar results were discovered in different subpopulations. Discussion/Conclusion: The SLR was inferior to LR on the survival of NSCLC patients with stage IA.