Impact of surgical approach on stage I small cell lung cancer according to the eighth edition of TNM classification: a population-based study

Background Limited evidence exists regarding the comparative effectiveness of lobectomy (L) and sublobar resection (sub-L) for early-stage small cell lung cancer (SCLC). Methods We identified patients with stage I (pT1-T2aN0M0) SCLC who underwent definitive surgery from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2019. Overall survival (OS) and lung cancer-specific death (LCSD) were assessed using Kaplan-Meier analysis, Cox regression model analysis, and competing risk model analysis. Propensity score matching (PSM) was employed to mitigate bias. Outcomes Among the 560 patients in this study, 383 underwent lobectomy, 177 patients underwent sublobar resection, with 138 undergoing wedge resections (WR) and 39 undergoing segmental resection (SR). L demonstrated better OS than sub-L for resected stage I SCLC before and after PSM (5-year OS: 52.2% vs. 37.8%, p < 0.001; 54.3% vs. 37.9%, p=0.025). LCSD did not significantly differ between L and sub-L groups before and after PSM (5-year LCSD: 36.5% vs. 43.0%, p=0.088; 34.5% vs. 39.1%, p=0.444). Multivariate Cox regression analysis (hazard ratio: 0.65, 95% CI 0.5 - 0.85, p = 0.002) and competing risk regression model analysis (sub-distribution hazard ratio: 0.76, 95% CI 0.57 – 1.02, P=0.07) further confirmed above conclusion. In subgroup analysis, L was associated with improved OS and reduced LCSD compared to sub-L among patients with pure SCLC. Conclusion Lung cancer-specific survival was similar between L and sub-L groups in early-stage SCLC. Sub-L was deemed suitable for specifically selected patients with SCLC.