Impact of pathologically confirmed inner lung tumors on nodal upstaging and feasibility of segmentectomy versus lobectomy

<h2>Abstract</h2><h3>Objectives</h3> Previous studies reported worse outcomes for radiographically central tumors, but the impact of pathologically confirmed tumor origin remains unclear. This study investigated whether pathologically determined inner lesions are associated with nodal upstaging and poorer prognosis than outer lesions, and examined segmentectomy feasibility versus lobectomy. <h3>Methods</h3> We retrospectively analyzed participants with clinical stage IA (Union for International Cancer Control version 8) non−small cell lung cancer who underwent segmentectomy and lobectomy between November 2007 and December 2022 at 2 Japanese centers. The location of the tumor origin was confirmed pathologically via the Walter classification. Tumors classified as central and intermediate were allocated to the inner group, whereas those classified as peripheral type were allocated to the outer group. The oncologic outcomes were compared between the 2 groups. After propensity score matching analysis on the basis of sex, age, pulmonary function, serum carcinoembryonic antigen level, and radiographic findings, we compared oncologic outcomes in patients who underwent segmentectomy (n = 99) and lobectomy (n = 99) in the inner group. <h3>Results</h3> The cohort comprised inner (n = 654) and outer (n = 1275) groups. Nodal upstaging was greater in the inner group (13.1% [86/654] vs 9.5% [121/1275], <i>P</i> = .015). Five-year recurrence-free survival (RFS) was lower in the inner group (73.1%; 95% CI, 69.4%-77.3% vs 79.4%; 95% CI, 76.7%-81.8%, <i>P</i> = .002). Multivariable analysis did not identify segmentectomy as significant for RFS (hazard ratio, 0.81; 95% CI, 0.58-1.13; <i>P</i> = .20). In matched inner lesions, segmentectomy and lobectomy showed similar RFS (83.6%; 95% CI, 76.3-93.1% vs 76.4%; 95% CI, 66.8-87.4%; <i>P</i> = .80). <h3>Conclusions</h3> Although worse prognosis and increased nodal upstaging should be considered in inner primary tumors, segmentectomy is an acceptable treatment option compared with lobectomy for pathologically confirmed inner-located early-stage NSCLC.