Comparison of survival outcomes between sublobar resection and lobectomy in pathological stage IA pulmonary invasive mucinous adenocarcinoma

This study aims to compare postoperative survival outcomes between pathological stage IA pulmonary invasive mucinous adenocarcinoma (IMA) and invasive non-mucinous adenocarcinoma (INMA) and assess the effectiveness of sublobar resection in patients with stage IA IMA. This study analyzed 113 patients with resected stage IA IMA (2015–2022) and 364 patients with resected stage IA INMA (2015–2019) from Guangdong Provincial People's Hospital. Propensity score matching (PSM) was applied to balance baseline characteristics. Survival curves were generated using the Kaplan–Meier method, and differences were evaluated with log-rank tests. Cox regression analysis was performed to identify predictors of survival. Before PSM, the IMA cohort exhibited a higher proportion of lower lobe foci (60.2 % versus 32.7 %; p < 0.001), a greater prevalence of stage IA1 disease (25.7 % versus 8.52 %; p < 0.001), and a lower frequency of sublobar resections (26.5 % versus 45.1 %; p = 0.001). Survival analysis demonstrated significantly reduced recurrence-free survival (RFS) and overall survival (OS) in patients with stage IA IMA compared to those with INMA (before PSM: RFS, p = 0.01; OS, p < 0.001; after PSM: RFS, p = 0.034; OS, p = 0.014). Pathological subtype and spread through air spaces were identified as independent predictors of RFS. Within the IMA group, statistically non-significant differences were observed between sublobar resection and lobectomy (before PSM: RFS, p = 0.17; OS, p = 0.27; after PSM: RFS, p = 0.71; OS, p = 0.37). Patients with stage IA IMA exhibited inferior survival outcomes compared to those with stage IA INMA. No significant survival difference was observed between sublobar resection and lobectomy in patients with stage IA IMA.