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David S. Ettinger, MD, FACP, FCCP


WCLC 2022: Noninferiority Trial of Lobar or Sublobar Resection for Peripheral NSCLC

By: Vanessa A. Carter, BS
Posted: Thursday, August 18, 2022

Everett Vokes, MD, of the University of Chicago Medicine and Biological Sciences, and colleagues conducted the phase III noninferiority CALGB 140503 (Alliance) trial of lobar or sublobar resection in patients with stage IA non–small cell lung cancer (NSCLC). Presented by Nasser Khaled Altorki, MD, of Weill Cornell Medicine, New York, during the International Association for the Study of Lung Cancer (IASLC) 2022 World Conference on Lung Cancer (WCLC; Abstract PL03.06), the results of this study suggest that sublobar resection is noninferior to traditional lobectomy.

The investigators focused on 1,080 patients with clinical stage IA, peripheral NSCLC who had pathologically confirmed node-negative disease in mediastinal and major hilar lymph nodes. A total of 697 participants were intraoperatively randomly assigned to undergo lobar (n = 357) or sublobar (n = 340) resection. Of note, random assignment was stratified by smoking status, histology, and tumor size.

General clinical characteristics and demographics were well balanced between the treatment arms, and 80% of surgical resections required minimally invasive approaches. The noninferiority significance boundary has not yet been crossed at the median follow-up of 7 years, as 30- and 90-day mortality rates were similar after lobar (1.1% and 1.7%) and sublobar (0.6% and 1.2%) resections.

For the primary endpoint of disease-free survival, the stratified hazard ratio was 0.999; the stratified hazard ratio for overall survival was 0.930. Furthermore, the sublobar and lobectomy arms demonstrated similar 5-year disease-free survival rates of 63.9%, and 64.3%, respectively.

Disclosure: For disclosures of the study authors, visit

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