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Gregory J. Riely, MD, PhD


Patient Age and Sex: Indicators for Segmentectomy vs Lobectomy in Pure-Solid NSCLC?

By: Chris Schimpf, BS
Posted: Friday, February 16, 2024

A team of Japanese researchers conducted a post hoc supplemental analysis of the phase III JCOG0802/WJOG4607L Japanese multicenter, open-label clinical trial to examine why segmentectomy was associated with better overall survival than lobectomy among participants who had non–small cell lung cancer (NSCLC) with a pure-solid appearance on thin-section CT. Aritoshi Hattori, MD, of the Juntendo University School of Medicine, Tokyo, and colleagues reported that survival outcomes of segmentectomy seemed to depend on patient age and sex. The results of the analysis were published in The Lancet Respiratory Medicine.

“In patients with radiologically pure-solid NSCLC, the finding of better overall survival in the segmentectomy group was driven by older age and male sex, whereas the finding of worse relapse-free survival in the segmentectomy group was driven by recurrence in younger and female patients,” the investigators reported. “Although results of this supplemental analysis were exploratory, they might indicate the necessity to personalize surgical treatment on the basis of radiological findings or patient baseline characteristics.”

Of the 1,106 participants in the study, 553 had radiologically pure-solid NSCLC and were eligible for the investigators’ supplemental analysis. Of them, 274 underwent lobectomy, and 279 underwent segmentectomy. Median patient age was 67, 63% were male, and 37% were female. The investigators observed better 5-year overall survival after segmentectomy among male patients (P = .0085) and patients aged 70 or older (P = .013). By contrast, they observed better 5-year relapse-free survival after lobectomy among female patients (P = .047) and patients younger than 70 (P = .049).

“By focusing on the results of radiologically pure-solid NSCLC, [this analysis] addresses worldwide concerns about whether segmentectomy is still appropriate for small-sized lung cancers with high malignancy,” the researchers added. They stressed that further research is necessary to determine clinically relevant indications for segmentectomy in radiologically pure-solid NSCLC.

Disclosure: For full disclosures of the study authors, visit

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