Lobar versus sub-lobar resection for clinical stage IA (≤ 2 cm) lung neuroendocrine tumor with spread through air spaces: a multi-center study

Hanbo Pan; Hang Chen; Weicheng Kong; Zhen Ge; Jiaqi Zhang; Wanyu Li; Yu Tian; Junwei Ning; Liang Fang; Zhizhuo Dai; Guomo Ruan; Zhongjie Chen; Min Zheng; Hui Wang; Ming Zhang; Ziming Li; Jia Huang; Chengwei Zhou; Guodong Xu; Hui Yin; Qingquan Luo

doi:10.1007/s13304-025-02289-9

Lobar versus sub-lobar resection for clinical stage IA (≤ 2 cm) lung neuroendocrine tumor with spread through air spaces: a multi-center study

Updates Surg. 2025 Jun 21. doi: 10.1007/s13304-025-02289-9. Online ahead of print.

Authors

Hanbo Pan^#¹, Hang Chen^#², Weicheng Kong^#³, Zhen Ge^#⁴, Jiaqi Zhang^#¹, Wanyu Li⁵, Yu Tian¹, Junwei Ning⁶, Liang Fang^{1

7

8}, Zhizhuo Dai⁹, Guomo Ruan¹⁰, Zhongjie Chen¹¹, Min Zheng⁶, Hui Wang¹, Ming Zhang⁵, Ziming Li¹², Jia Huang¹, Chengwei Zhou⁴, Guodong Xu², Hui Yin^{13

14}, Qingquan Luo¹⁵

Affiliations

¹ Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 Huaihai West Road, Shanghai, 200030, China.
² Department of Cardiothoracic Surgery, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, 315040, China.
³ Department of Thoracic Surgery, Putuo District People's Hospital, Zhoushan, 316100, China.
⁴ Department of Cardiothoracic Surgery, The First Affiliated Hospital of Ningbo University, Ningbo, 315020, China.
⁵ Department of Integrated Traditional Chinese and Western Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China.
⁶ Department of Thoracic Surgery, Shanghai Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200050, China.
⁷ Department of Thoracic Surgery, The First Affiliated Hospital of Shaoyang University, 39 Tongqu Street, Shaoyang, 422001, China.
⁸ Department of Thoracic Surgery, The Central Hospital of Shaoyang, Shaoyang, 422000, China.
⁹ School of Life Science and Technology, ShanghaiTech University, 393 Middle Huaxia Road, Shanghai, 201210, China.
¹⁰ Wenzhou People's Hospital, Shanghai University, Wenzhou, 325000, China.
¹¹ Department of Cardiothoracic Surgery, Ningbo Beilun District People's Hospital, Ningbo, 315800, China.
¹² Department of Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
¹³ Department of Thoracic Surgery, The First Affiliated Hospital of Shaoyang University, 39 Tongqu Street, Shaoyang, 422001, China. dr_yinhui@126.com.
¹⁴ Department of Thoracic Surgery, The Central Hospital of Shaoyang, Shaoyang, 422000, China. dr_yinhui@126.com.
¹⁵ Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 Huaihai West Road, Shanghai, 200030, China. luoqingquan@hotmail.com.

^# Contributed equally.

PMID: 40544229
DOI: 10.1007/s13304-025-02289-9

Abstract

Tumor spread through air spaces (STAS) is an important prognostic factor for lung cancer, including lung neuroendocrine tumors (NETs). The comparative oncological efficacy of lobar resection (LR) and sub-lobar resection (SR) for clinical stage IA (cIA) STAS-positive NETs remains unclear. This retrospective study aimed to review outcomes in patients with consecutive peripheral cIA (tumors ≤ 2 cm) STAS-positive NET patients (excluding small cell lung cancer) who underwent surgery between 2012 and 2020 at six high-volume tertiary Chinese institutions. SR was commonly performed for patients ineligible for LR for various reasons. The primary endpoint was recurrence-free survival (RFS), while the secondary endpoint was overall survival (OS). Propensity score matching (PSM) was utilized to minimize selection bias. Among the 599 eligible patients, PSM resulted in 328 LR and 164 SR cases with well-balanced baseline characteristics. During a median follow-up of 6.8 years, LR significantly improved 5-year RFS (68.3% versus 54.3%, hazard ratio (HR) [95% confidence interval (CI)] = 0.595 [0.449-0.787], P < 0.001) and OS (79.0% versus 72.6%, HR [95%CI] = 0.650 [0.484-0.872], P = 0.025), and reduced postoperative recurrence (34.5% versus 51.2%, P < 0.001) and mortality (32.3% versus 46.3%, P = 0.002) rates compared to SR. Subgroup analysis revealed that LR improved RFS (59.2% versus 42.5%, HR [95%CI] = 0.553 [0.408-0.749], P < 0.001) and OS (74.0% versus 63.7%, HR [95%CI] = 0.710 [0.509-0.989], P = 0.043) compared to SR in patients with large cell neuroendocrine carcinoma (LCNEC), while both approaches yielded comparable prognoses in patients with carcinoid. Furthermore, segmentectomy exhibited survival outcomes comparable to those of wedge resection. Collectively, LR demonstrated better survival outcomes than SR for cIA STAS-positive NETs, with the benefit being influenced by the tumor histology. LCNEC was associated with a 3.3-fold higher risk of recurrence and a 4.0-fold higher risk of mortality than carcinoid.

Keywords: Lobar resection; Lung neuroendocrine tumor; Overall survival; Recurrence-free survival; Spread through air spaces; Sub-lobar resection.

Abstract

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